Provider Demographics
NPI:1215310628
Name:SELAH HOUSE, INC
Entity type:Organization
Organization Name:SELAH HOUSE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-641-0022
Mailing Address - Street 1:1201 E 5TH ST
Mailing Address - Street 2:SUITE 3000
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46012-3472
Mailing Address - Country:US
Mailing Address - Phone:765-641-0022
Mailing Address - Fax:
Practice Address - Street 1:2541 NORTHSHORE BLVD
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46011-9600
Practice Address - Country:US
Practice Address - Phone:765-641-0022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-02
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital