=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740304526
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAINT CATHERINE HOSPITAL OF INDIANA, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2007
-----------------------------------------------------
Last Update Date | 11/08/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2200 MARKET STREET
-----------------------------------------------------
City | CHARLESTOWN
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47111-9553
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-256-3301
-----------------------------------------------------
Fax | 812-256-6859
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2200 MARKET STREET
-----------------------------------------------------
City | CHARLESTOWN
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47111-9553
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-256-3301
-----------------------------------------------------
Fax | 812-256-6859
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BUSINESS OFFICE / BILLING
-----------------------------------------------------
Name | JULIA COOPER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 812-256-7404
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 273R00000X
-----------------------------------------------------
Taxonomy Name | Psychiatric Hospital Unit
-----------------------------------------------------
License Number | 06-004975-1
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 273R00000X
-----------------------------------------------------
Taxonomy Name | Psychiatric Hospital Unit
-----------------------------------------------------
License Number | 12-004975-1
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------