Healthcare Provider Details

I. General information

NPI: 1568417004
Provider Name (Legal Business Name): COMMUNITY HOSPITAL OF BREMEN, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 12/01/2022
Certification Date: 12/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 HIGH ROAD
BREMEN IN
46506
US

IV. Provider business mailing address

1020 HIGH ROAD P.O. BOX 8
BREMEN IN
46506
US

V. Phone/Fax

Practice location:
  • Phone: 574-546-2211
  • Fax: 574-546-4312
Mailing address:
  • Phone: 574-546-2211
  • Fax: 574-546-4312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number05-005097-2
License Number StateIN

VIII. Authorized Official

Name: IRENE MAFFETONE
Title or Position: CONTRACTING SPECIALIST
Credential:
Phone: 574-647-1040