Provider Demographics
NPI:1871689539
Name:FRANCISCAN HEALTH LAFAYETTE
Entity Type:Organization
Organization Name:FRANCISCAN HEALTH LAFAYETTE
Other - Org Name:ST. ELIZABETH INPATIENT REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRANCE
Authorized Official - Middle Name:E
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-502-4440
Mailing Address - Street 1:1501 HARTFORD ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47904-2134
Mailing Address - Country:US
Mailing Address - Phone:765-423-6780
Mailing Address - Fax:
Practice Address - Street 1:1501 HARTFORD ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-2134
Practice Address - Country:US
Practice Address - Phone:765-423-6780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRANCISCAN ST. ELIZABETH HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-04
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN060050961273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN15T109Medicare Oscar/Certification