Provider Demographics
NPI:1770581902
Name:HOWARD REGIONAL SPECIALTY CARE LLC
Entity type:Organization
Organization Name:HOWARD REGIONAL SPECIALTY CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-454-4507
Mailing Address - Street 1:829 N DIXON RD
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46901-1795
Mailing Address - Country:US
Mailing Address - Phone:765-452-6700
Mailing Address - Fax:765-236-4011
Practice Address - Street 1:829 N DIXON RD
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-1795
Practice Address - Country:US
Practice Address - Phone:765-452-6700
Practice Address - Fax:765-236-4011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200484520AMedicaid
IN200504370AMedicaid
IN200504370AMedicaid