Healthcare Provider Details

I. General information

NPI: 1609964287
Provider Name (Legal Business Name): COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 N MADISON AVE
ANDERSON IN
46011-3453
US

IV. Provider business mailing address

4416 E 200 S
ANDERSON IN
46017-9728
US

V. Phone/Fax

Practice location:
  • Phone: 765-298-2229
  • Fax:
Mailing address:
  • Phone: 765-378-5084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number33000495A
License Number StateIN

VIII. Authorized Official

Name: MS. CAROL LYNN WHITESEL
Title or Position: DIRECTOR
Credential: RN
Phone: 765-298-2229