Provider Demographics
NPI:1790285500
Name:COMMUNITY HEALTH NETWORK REHABILITATION HOSPITAL SOUTH, LLC
Entity Type:Organization
Organization Name:COMMUNITY HEALTH NETWORK REHABILITATION HOSPITAL SOUTH, LLC
Other - Org Name:COMMUNITY HEALTH NETWORK REHABILITATION HOSPITAL SOUTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HOSPITAL CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-215-3800
Mailing Address - Street 1:607 GREENWOOD SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-6377
Mailing Address - Country:US
Mailing Address - Phone:317-215-3800
Mailing Address - Fax:
Practice Address - Street 1:607 GREENWOOD SPRINGS DR
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-6377
Practice Address - Country:US
Practice Address - Phone:317-215-3800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-19
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital