1023140282 NPI number — NORTHWEST INDIANA REHABILITATION SERVICES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023140282 NPI number — NORTHWEST INDIANA REHABILITATION SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHWEST INDIANA REHABILITATION SERVICES, 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:
1023140282
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:
8517 FOREST AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MUNSTER
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46321
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-836-1916
Provider Business Mailing Address Fax Number:
219-836-4883

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8517 FOREST AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MUNSTER
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46321-2120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-836-1916
Provider Business Practice Location Address Fax Number:
219-836-4883
Provider Enumeration Date:
03/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PLEITNER
Authorized Official First Name:
CHRISTINE
Authorized Official Middle Name:
MONICA
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
219-836-1916

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  31000122A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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