Provider Demographics
NPI:1356501506
Name:SOUTHERN INDIANA REHAB HOSPITAL
Entity Type:Organization
Organization Name:SOUTHERN INDIANA REHAB HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:NAPIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-941-6106
Mailing Address - Street 1:PO BOX 2587
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-2587
Mailing Address - Country:US
Mailing Address - Phone:502-587-4099
Mailing Address - Fax:
Practice Address - Street 1:3104 BLACKISTON BLVD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-9579
Practice Address - Country:US
Practice Address - Phone:812-941-8300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200715810AMedicaid