Basic Information
| Provider Information | |||||||||
| NPI: | 1205293701 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SOUTHERN INDIANA TREATMENT CENTER | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 6509 CHARLESTOWN PIKE | ||||||||
| Address2: | |||||||||
| City: | CHARLESTOWN | ||||||||
| State: | IN | ||||||||
| PostalCode: | 471119622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122564686 | ||||||||
| FaxNumber: | 8122563949 | ||||||||
| Practice Location | |||||||||
| Address1: | 6509 CHARLESTOWN PIKE | ||||||||
| Address2: | |||||||||
| City: | CHARLESTOWN | ||||||||
| State: | IN | ||||||||
| PostalCode: | 471119622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122564686 | ||||||||
| FaxNumber: | 8122563949 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2016 | ||||||||
| LastUpdateDate: | 01/28/2016 | ||||||||
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| AuthorizedOfficialLastName: | FIFE | ||||||||
| AuthorizedOfficialFirstName: | DEBRA | ||||||||
| AuthorizedOfficialMiddleName: | LYNN | ||||||||
| AuthorizedOfficialTitleorPosition: | LPN | ||||||||
| AuthorizedOfficialTelephone: | 8122564686 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251J00000X | 27025026A | IN | Y | Agencies | Nursing Care |
No ID Information.