Provider Demographics
NPI:1639479108
Name:COURTYARD REHABILITATION CENTER, INC
Entity Type:Organization
Organization Name:COURTYARD REHABILITATION CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:LARRY
Authorized Official - Last Name:CENTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-324-9411
Mailing Address - Street 1:2400 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46528-5010
Mailing Address - Country:US
Mailing Address - Phone:574-533-0351
Mailing Address - Fax:574-533-5714
Practice Address - Street 1:2400 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46528-5010
Practice Address - Country:US
Practice Address - Phone:574-533-0351
Practice Address - Fax:574-533-5714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-29
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility