Provider Demographics
NPI:1295901007
Name:WELLSTONE REGIONAL HOSPITAL LLC
Entity type:Organization
Organization Name:WELLSTONE REGIONAL HOSPITAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SRVP CFO
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:FILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-768-3300
Mailing Address - Street 1:2700 VISSING PARK RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-5989
Mailing Address - Country:US
Mailing Address - Phone:812-284-8000
Mailing Address - Fax:812-704-1221
Practice Address - Street 1:2700 VISSING PARK RD
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-5989
Practice Address - Country:US
Practice Address - Phone:812-284-8000
Practice Address - Fax:812-704-1221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN8483809 73741323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY02000057Medicaid
IN200813990AMedicaid
KY02000057Medicaid