=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639719602
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REHABILITATION HOSPITAL OF NORTHERN INDIANA, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/08/2020
-----------------------------------------------------
Last Update Date | 11/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4807 EDISON LAKES PARKWAY
-----------------------------------------------------
City | MISHAWAKA
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46545-1112
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 574-243-7727
-----------------------------------------------------
Fax | 574-243-7728
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1024 N GALLOWAY AVE STE 102
-----------------------------------------------------
City | MESQUITE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75149-2434
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-216-2299
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT AND SECRETARY
-----------------------------------------------------
Name | DENISE KANN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 972-216-2299
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 283X00000X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Hospital
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------