| Memorial Epworth Center | |
|
420 N Niles Ave South Bend IN 46617-1918 | |
| (574) 647-8400 | |
| (574) 647-8410 |
| Full Name | Memorial Epworth Center |
|---|---|
| Speciality | Psychiatric Unit |
| Location | 420 N Niles Ave, South Bend, Indiana |
| Authorized Official Name and Position | Jeffrey P Costello (VP/CFO) |
| Authorized Official Contact | 5746473549 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Memorial Epworth Center 615 N Michigan St South Bend IN 46601-1033 Ph: (574) 647-7167 | Memorial Epworth Center 420 N Niles Ave South Bend IN 46617-1918 Ph: (574) 647-8400 |
| NPI Number | 1376841395 |
|---|---|
| Provider Enumeration Date | 03/01/2011 |
| Last Update Date | 02/21/2022 |
| Certification Date | 02/21/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376841395 | NPI | - | NPPES |
| 100269890B | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 273R00000X | Psychiatric Unit | 005053 (Indiana) | Primary |
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