Provider Demographics
NPI:1598003782
Name:NORTHERN INDIANA REHAB HOSPITAL, LLC
Entity Type:Organization
Organization Name:NORTHERN INDIANA REHAB HOSPITAL, LLC
Other - Org Name:DOCTORS NEUROMEDICAL HOSPITAL & BRAIN INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:CAMERON
Authorized Official - Middle Name:R
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:574-546-3830
Mailing Address - Street 1:PO BOX 36
Mailing Address - Street 2:
Mailing Address - City:BREMEN
Mailing Address - State:IN
Mailing Address - Zip Code:46506-0036
Mailing Address - Country:US
Mailing Address - Phone:574-546-3830
Mailing Address - Fax:574-546-3881
Practice Address - Street 1:411 S WHITLOCK ST
Practice Address - Street 2:
Practice Address - City:BREMEN
Practice Address - State:IN
Practice Address - Zip Code:46506-1626
Practice Address - Country:US
Practice Address - Phone:574-546-3830
Practice Address - Fax:574-546-3881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-22
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12-004838-1282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200817930Medicaid
IN150180Medicare Oscar/Certification