Provider Demographics
NPI:1134972706
Name:COMMUNITY STROKE AND REHABILITATION CENTER INC
Entity type:Organization
Organization Name:COMMUNITY STROKE AND REHABILITATION CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:BOLDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-661-6055
Mailing Address - Street 1:PO BOX 3032
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-0032
Mailing Address - Country:US
Mailing Address - Phone:219-934-8888
Mailing Address - Fax:219-934-8889
Practice Address - Street 1:10215 BROADWAY
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-8001
Practice Address - Country:US
Practice Address - Phone:219-661-6100
Practice Address - Fax:219-703-6800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital