Provider Demographics
NPI:1508168220
Name:DEACONESS WOMEN'S HOSPITAL OF SOUTHERN IN
Entity Type:Organization
Organization Name:DEACONESS WOMEN'S HOSPITAL OF SOUTHERN IN
Other - Org Name:WELLNESS AND COUNSELING SERVICES AT THE WOMEN'S HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CADY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-842-4263
Mailing Address - Street 1:4199 GATEWAY BLVD
Mailing Address - Street 2:SUITE 2200
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-8940
Mailing Address - Country:US
Mailing Address - Phone:812-842-4200
Mailing Address - Fax:812-842-4226
Practice Address - Street 1:4199 GATEWAY BLVD.
Practice Address - Street 2:SUITE 2200
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-8940
Practice Address - Country:US
Practice Address - Phone:812-842-4200
Practice Address - Fax:812-842-4226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-01
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10-002855-1163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Single Specialty