1770790834 NPI number — GIBSON COUNTY AREA REHABILITATION CENTERS INC

Table of content: (NPI 1770790834)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770790834 NPI number — GIBSON COUNTY AREA REHABILITATION CENTERS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GIBSON COUNTY AREA REHABILITATION CENTERS INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770790834
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRINCETON
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47670-0005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-386-6312
Provider Business Mailing Address Fax Number:
812-385-8778

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HWY. 64 WEST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRINCEON
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47670
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-386-6312
Provider Business Practice Location Address Fax Number:
812-385-8778
Provider Enumeration Date:
05/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
COCKRUM
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
J
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
812-386-6312

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 320900000X , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com