Basic Information
| Provider Information | |||||||||
| NPI: | 1609136159 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RUSH MEMORIAL HOSPITAL | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | WHITE RIVER LODGE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1300 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | RUSHVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461731116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7659324111 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3710 KENNY SIMPSON LN | ||||||||
| Address2: | |||||||||
| City: | BEDFORD | ||||||||
| State: | IN | ||||||||
| PostalCode: | 474215632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122757006 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2012 | ||||||||
| LastUpdateDate: | 10/01/2012 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SMITH | ||||||||
| AuthorizedOfficialFirstName: | BRAD | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 7659327513 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.