Basic Information
| Provider Information | |||||||||
| NPI: | 1639479108 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COURTYARD REHABILITATION CENTER, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2400 COLLEGE AVE | ||||||||
| Address2: | |||||||||
| City: | GOSHEN | ||||||||
| State: | IN | ||||||||
| PostalCode: | 465285010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5745330351 | ||||||||
| FaxNumber: | 5745335714 | ||||||||
| Practice Location | |||||||||
| Address1: | 2400 COLLEGE AVE | ||||||||
| Address2: | |||||||||
| City: | GOSHEN | ||||||||
| State: | IN | ||||||||
| PostalCode: | 465285010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5745330351 | ||||||||
| FaxNumber: | 5745335714 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/29/2010 | ||||||||
| LastUpdateDate: | 10/29/2010 | ||||||||
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| AuthorizedOfficialLastName: | CENTERS | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | LARRY | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2693249411 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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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.