1871973032 NPI number — FRANCISCAN HEALTH RENSSELAER, INC.

Table of content: (NPI 1871973032)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871973032 NPI number — FRANCISCAN HEALTH RENSSELAER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FRANCISCAN HEALTH RENSSELAER, 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:
FRANCISCAN HEALTH AND FITNESS
Provider Other Organization Name Type Code:
3
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:
1871973032
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 781076
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DETROIT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48278-1076
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-528-4800
Provider Business Mailing Address Fax Number:
317-865-1479

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4109 W STATE ROAD 10
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHEATFIELD
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46392-7008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-956-4000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/03/2015

Additional Information

Authorized Official

Authorized Official Last Name:
WILSON
Authorized Official First Name:
TERRANCE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
765-502-4440

Provider Taxonomy Codes

  • Taxonomy code: 282NC0060X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100269680A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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