Provider Demographics
NPI:1265477632
Name:COMMUNITY HEALTH NETWORK, INC
Entity Type:Organization
Organization Name:COMMUNITY HEALTH NETWORK, INC
Other - Org Name:COMMUNITY FAIRBANKS BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD, EVP
Authorized Official - Prefix:
Authorized Official - First Name:RAMARAO
Authorized Official - Middle Name:
Authorized Official - Last Name:YELETI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-621-9002
Mailing Address - Street 1:6950 HILLSDALE CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2040
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6950 HILLSDALE CT
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-2040
Practice Address - Country:US
Practice Address - Phone:317-621-7740
Practice Address - Fax:317-621-7608
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY HEALTH NETWORK, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-18
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100270530AMedicaid
IN165490Medicare PIN