Organization
MEMORIAL HOSPITAL OF SOUTH BEND
Active
Organization
MEMORIAL HOSPITAL OF SOUTH BEND
Active
Other names
Memorial Epworth Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFFREY P COSTELLO (VP/CFO)
(574) 647-3549
Entity
Organization
Contact information
Practice address
420 N NILES AVE, SOUTH BEND, IN 46617-1918
(574) 647-8400
(574) 647-8410
Mailing address
615 N MICHIGAN ST, SOUTH BEND, IN 46601-1033
(574) 647-7167
Taxonomy
Speciality
Code
Description
License number
State
273R00000X
Psychiatric Hospital Unit
Primary
005053
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100269890B
—
IN
Enumeration date
03/01/2011
Last updated
02/21/2022
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