Organization
SELECT SPECIALTY HOSPITAL - NORTHWEST INDIANA INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL E. TARVIN (VICE PRESIDENT)
(717) 972-1100
Entity
Organization
Contact information
Practice address
5454 HOHMAN AVE, 5TH FLOOR, HAMMOND, IN 46325-1931
(219) 852-2409
(219) 933-2298
Mailing address
4714 GETTYSBURG RD, LEGAL DEPT., MECHANICSBURG, PA 17055-4325
(717) 972-1100
(717) 975-9981
Taxonomy
Speciality
Code
Description
License number
State
282E00000X
Long Term Care Hospital
Primary
008899
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000112474
BCBS IN
IN
05
—
200110710A
—
IN
Enumeration date
07/26/2005
Last updated
09/02/2010
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