Basic Information
| Provider Information | |||||||||
| NPI: | 1801260765 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | REHABILITATION HOSPITAL OF INDIANA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9531 VALPARAISO CT | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462681130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178798940 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9531 VALPARAISO CT | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462681130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178798940 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2015 | ||||||||
| LastUpdateDate: | 11/16/2015 | ||||||||
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| AuthorizedOfficialLastName: | TREXLER | ||||||||
| AuthorizedOfficialFirstName: | LANCE | ||||||||
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| AuthorizedOfficialTitleorPosition: | NEUROPSYCHOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 3178798940 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PH.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 283X00000X | 88000118A | IN | Y | Hospitals | Rehabilitation Hospital |
ID Information
| ID | Type | State | Issuer | Description | 88000118A | 01 | IN | MENTAL HEALTH ASSOCIATE | OTHER | 4669 | 01 | IN | RHI EMPLOYEE NUMBER | OTHER |