Provider Demographics
NPI:1679876940
Name:TRIUMPH REHABILITATION HOSPITAL NORTHERN INDIANA LLC
Entity type:Organization
Organization Name:TRIUMPH REHABILITATION HOSPITAL NORTHERN INDIANA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:A
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-596-7563
Mailing Address - Street 1:215 W 4TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46544-1917
Mailing Address - Country:US
Mailing Address - Phone:574-252-5000
Mailing Address - Fax:574-280-5889
Practice Address - Street 1:215 W 4TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46544-1917
Practice Address - Country:US
Practice Address - Phone:574-252-5000
Practice Address - Fax:574-280-5889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-08
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
No283X00000XHospitalsRehabilitation Hospital