1750667184 NPI number — ELKHART GENERAL HOSPITAL FOUNDATION, INC.

Table of content: (NPI 1750667184)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750667184 NPI number — ELKHART GENERAL HOSPITAL FOUNDATION, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELKHART GENERAL HOSPITAL FOUNDATION, 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:
6
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:
1750667184
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/31/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 EAST BLVD
Provider Second Line Business Mailing Address:
EGH FOUNDATION, INC./LIFELINE
Provider Business Mailing Address City Name:
ELKHART
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46514-2483
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
574-524-7458
Provider Business Mailing Address Fax Number:
574-523-3383

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2020 INDUSTRIAL PARKWAY
Provider Second Line Business Practice Location Address:
LIFELINE
Provider Business Practice Location Address City Name:
ELKHART
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46516-5411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-524-7503
Provider Business Practice Location Address Fax Number:
574-524-7500
Provider Enumeration Date:
10/31/2011

Additional Information

Authorized Official

Authorized Official Last Name:
HOUSAND
Authorized Official First Name:
JONATHAN
Authorized Official Middle Name:
W.
Authorized Official Title or Position:
EX. DIRECTOR OF EGH FOUNDATION, INC
Authorized Official Telephone Number:
574-524-7458

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X , with the licence number:  11-005017-1 , 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)

  • Identifier: PENDING . This is a "MEDICAID WAIVER" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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