Healthcare Provider Details

I. General information

NPI: 1023965795
Provider Name (Legal Business Name): SAINT JOSEPH REGIONAL MEDICAL CENTER-SOUTH BEND CAMPUS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 E DOUGLAS RD STE 123B
MISHAWAKA IN
46545-1464
US

IV. Provider business mailing address

611 E DOUGLAS RD STE 123B
MISHAWAKA IN
46545-1464
US

V. Phone/Fax

Practice location:
  • Phone: 574-948-4420
  • Fax:
Mailing address:
  • Phone: 574-948-4420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number StateNULL

VIII. Authorized Official

Name: CHERYL SWIHART
Title or Position: PROVIDER ENROLLMENT
Credential:
Phone: 574-335-8717