Basic Information
| Provider Information | |||||||||
| NPI: | 1679876940 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TRIUMPH REHABILITATION HOSPITAL NORTHERN INDIANA LLC | ||||||||
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| OtherOrganizationName: | KINDRED HOSPITAL NORTHERN INDIANA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 215 W 4TH ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | MISHAWAKA | ||||||||
| State: | IN | ||||||||
| PostalCode: | 465441917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5742525000 | ||||||||
| FaxNumber: | 5742805889 | ||||||||
| Practice Location | |||||||||
| Address1: | 215 W 4TH ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | MISHAWAKA | ||||||||
| State: | IN | ||||||||
| PostalCode: | 465441917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5742525000 | ||||||||
| FaxNumber: | 5742805889 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2010 | ||||||||
| LastUpdateDate: | 06/04/2015 | ||||||||
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| AuthorizedOfficialLastName: | WEAVER | ||||||||
| AuthorizedOfficialFirstName: | MARILYN | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | ASSISTANT SECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 5025967563 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 283X00000X | N | Hospitals | Rehabilitation Hospital | 282E00000X | Y | Hospitals | Long Term Care Hospital |
No ID Information.