Healthcare Provider Details

I. General information

NPI: 1821040031
Provider Name (Legal Business Name): HENDRICKS COUNTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 06/15/2022
Certification Date: 06/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 E BURKS DR
BLOOMINGTON IN
47401-8459
US

IV. Provider business mailing address

155 E BURKS DR
BLOOMINGTON IN
47401-8459
US

V. Phone/Fax

Practice location:
  • Phone: 812-332-4437
  • Fax: 812-335-3672
Mailing address:
  • Phone: 812-332-4437
  • Fax: 812-335-3672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number06-000177-1
License Number StateIN

VIII. Authorized Official

Name: KEVIN P SPEER
Title or Position: PRESIDENT/CEO
Credential:
Phone: 317-745-4451