Provider Demographics
NPI:1699974568
Name:SELAH HOUSE, LLC
Entity type:Organization
Organization Name:SELAH HOUSE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:HINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-641-0022
Mailing Address - Street 1:1106 MERIDIAN STREET
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46016
Mailing Address - Country:US
Mailing Address - Phone:765-715-5585
Mailing Address - Fax:765-641-0066
Practice Address - Street 1:1180 N. 300 EAST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46012
Practice Address - Country:US
Practice Address - Phone:765-715-5585
Practice Address - Fax:765-641-0066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1555-1-PIP283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN006060800359OtherSTATE CERTIFICATION CONTR
IN03266OtherIAEDP