Provider Demographics
NPI: | 1871863423 |
---|---|
Name: | COLUMBUS HOSPITAL, LLC |
Entity type: | Organization |
Organization Name: | COLUMBUS HOSPITAL, LLC |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | KEVIN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | RECKELHOFF |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 800-562-5213 |
Mailing Address - Street 1: | 2223 POSHARD DR |
Mailing Address - Street 2: | |
Mailing Address - City: | COLUMBUS |
Mailing Address - State: | IN |
Mailing Address - Zip Code: | 47203-1844 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 800-562-5213 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2223 POSHARD DR |
Practice Address - Street 2: | |
Practice Address - City: | COLUMBUS |
Practice Address - State: | IN |
Practice Address - Zip Code: | 47203-1844 |
Practice Address - Country: | US |
Practice Address - Phone: | 800-562-5213 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2012-01-12 |
Last Update Date: | 2012-01-12 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
IN | 56765519873858 | 101YM0800X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Single Specialty |