Provider Demographics
NPI:1255740189
Name:RIVERCREST SPECIALTY HOSPITAL, LLC
Entity type:Organization
Organization Name:RIVERCREST SPECIALTY HOSPITAL, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CORP BOD
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:KELTNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-319-6552
Mailing Address - Street 1:112 W JEFFERSON BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601-1921
Mailing Address - Country:US
Mailing Address - Phone:574-255-1400
Mailing Address - Fax:574-255-1840
Practice Address - Street 1:1625 E JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-7103
Practice Address - Country:US
Practice Address - Phone:574-255-1400
Practice Address - Fax:574-255-1840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-05
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital