WAGGONER
NPI 1689792574
Intermediate Care Facility, Intellectual Disabilities in Evansville, IN

Active since March 27, 2007
3512 WAGGONER AVE, EVANSVILLE, IN 47714(812) 433-3535 Get Directions Write a Review

NPPES record last updated: July 16, 2008. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Waggoner NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

WAGGONER (NPI 1689792574) is a healthcare organization registered as an intermediate care facility, intellectual disabilities in Evansville, Indiana and active in the NPI registry since March 2007. The organization lists Deena Ombres, Privacy Officer, as its authorized official.

NPPES Registry Identity

NPI1689792574
Entity TypeOrganization
Primary Taxonomy315P00000X
Legal Business NameNORMAL LIFE OF INDIANA
Location Address3512 WAGGONER AVEEvansville, IN 47714-5463
Mailing Address9901 Linn Station RdLouisville, KY 40223-3808 · (800) 866-0860
Organization SubpartNo
Authorized OfficialDeena OmbresPrivacy Officer · (502) 394-2387
Enumeration DateMarch 27, 2007
Last NPPES UpdateJuly 16, 2008
NPI 1689792574 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyIntermediate Care Facility, Intellectual DisabilitiesNursing & Custodial Care Facilities
Taxonomy Code315P00000X
Definition

An intermediate care facility providing services for individuals with intellectual disabilities.

3512 WAGGONER AVE, Evansville, IN 47714

Other Names 1

Other NameWaggoner

Other Identifiers 1

Medicaid100234400AIN

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1689792574, enumerated as an "organization" on March 27, 2007.

The provider is located at 3512 WAGGONER AVE EVANSVILLE, IN 47714 and the phone number is (812) 433-3535.

Intermediate Care Facility, Intellectual Disabilities with taxonomy code 315P00000X.

The provider might be accepting Accepts: Medicare and Medicaid. Please consult your insurance carrier or call the provider to verify.