1982651782 NPI number — HENDRICKS COUNTY HOSPITAL

Table of content: (NPI 1982651782)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982651782 NPI number — HENDRICKS COUNTY HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HENDRICKS COUNTY HOSPITAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LIFE CARE CENTER OF MICHIGAN CITY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982651782
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/20/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3001 KEITH ST NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37312-3713
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-473-5751
Provider Business Mailing Address Fax Number:
423-339-8342

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
802 E US HIGHWAY 20
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MICHIGAN CITY
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46360-7424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-872-7251
Provider Business Practice Location Address Fax Number:
219-873-0387
Provider Enumeration Date:
05/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SPEER
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
P.
Authorized Official Title or Position:
PRESIDENT AND CEO
Authorized Official Telephone Number:
317-745-4451

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  050002361 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100287700 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com