Provider Demographics
NPI:1902878994
Name:COMMUNITY HOWARD REGIONAL HEALTH, INC
Entity Type:Organization
Organization Name:COMMUNITY HOWARD REGIONAL HEALTH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:SHIRENE
Authorized Official - Last Name:THARP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-298-5125
Mailing Address - Street 1:3500 S LAFOUNTAIN ST
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-3803
Mailing Address - Country:US
Mailing Address - Phone:765-453-0702
Mailing Address - Fax:765-453-8087
Practice Address - Street 1:3500 S LAFOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-3803
Practice Address - Country:US
Practice Address - Phone:765-453-0702
Practice Address - Fax:765-453-8087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-03
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN060050071282N00000X, 282N00000X
IN3416L0300X, 261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No3416L0300XTransportation ServicesAmbulanceLand Transport
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100136240DMedicaid
IN201093040Medicaid
IN201093730Medicaid
IN100136240DMedicaid
IN150007Medicare PIN
IN100268730AMedicaid
IN200153340AMedicaid
IN100268740AMedicaid