Healthcare Provider Details

I. General information

NPI: 1033115605
Provider Name (Legal Business Name): SELECT SPECIALTY HOSPITAL - BEECH GROVE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 08/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8060 KNUE RD
INDIANAPOLIS IN
46250-1976
US

IV. Provider business mailing address

4714 GETTYSBURG RD LEGAL DEPT.
MECHANICSBURG PA
17055-4325
US

V. Phone/Fax

Practice location:
  • Phone: 317-783-8731
  • Fax: 317-783-8989
Mailing address:
  • Phone: 717-972-1100
  • Fax: 717-975-9981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number008900
License Number StateIN

VIII. Authorized Official

Name: MR. MICHAEL E. TARVIN
Title or Position: VICE PRESIDENT
Credential:
Phone: 717-972-1100