Select Specialty Hospital - Fort Wayne Inc

Primary specialty

Long Term Care HospitalTaxonomy code 282E00000X

License

009856 Issued in IN

Legal business name

SELECT SPECIALTY HOSPITAL - FORT WAYNE INC

Practice address

700 Broadway
7TH FL East
Fort Wayne, IN 46802-1402

Phone

(260) 425-3811

Fax

(260) 425-3812

NPI assigned

Jul 20, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Michael E. Tarvin

Title

Vice President

Phone

(717) 972-1100

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Hospital certification: CCN 152016

Legal name

SELECT SPECIALTY HOSPITAL-FORT WAYNE

Certification status

Terminated Voluntary: merger or closure, Nov 18, 2016

Provider type (POS)

Hospital – Long-term

Participating since

Jul 1, 1997

Last certification

Nov 18, 2004

Beds

32

Ownership / control type

Private (for profit)

Facility address

700 Broadway 7TH FL E
Fort Wayne, IN 46802

Hospital certification: CCN 153035

Legal name

INTENSIVE HOSPITAL OF FORT WAYNE INC

Certification status

Terminated Other: provider status change, Jul 1, 1997

Provider type (POS)

Hospital – Rehabilitation

Participating since

Jan 2, 1997

Last certification

Jan 2, 1997

Beds

11

Ownership / control type

Private (for profit)

Facility address

700 Broadway
Fort Wayne, IN 46802

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Darlene M Degener, NP-C

  • Physical Therapist
  • Fort Wayne, IN
  • NPI 1467724856
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1121817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1283385600000",
    "number": "1104825140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4714 GETTYSBURG RD",
            "address_2": "LEGAL DEPT.",
            "city": "MECHANICSBURG",
            "state": "PA",
            "postal_code": "170554325",
            "telephone_number": "717-972-1100",
            "fax_number": "717-975-9981"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 BROADWAY",
            "address_2": "7TH FL EAST",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468021402",
            "telephone_number": "260-425-3811",
            "fax_number": "260-425-3812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SELECT SPECIALTY HOSPITAL - FORT WAYNE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-20",
        "last_updated": "2010-09-02",
        "status": "A",
        "authorized_official_last_name": "TARVIN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "717-972-1100",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282E00000X",
            "taxonomy_group": "",
            "desc": "Long Term Care Hospital",
            "state": "IN",
            "license": "009856",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS IN",
            "identifier": "000000246982",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Holly Ann Seidel
• Jenny Elizabeth Seiss, PSY. D., HSPP
• Seiss, LLC
• Nicholas Selby
• Select Physical Therapy Holdings, Inc.
• Self Care Counseling, LLC
• Rita Kay Self, M.S.
• Jodi Selking
• Storm Selking
• Kyle Sell

• Long Term Care Hospital in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Long Term Care Hospital in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.