Healthcare Provider Details

I. General information

NPI: 1982645404
Provider Name (Legal Business Name): MAJOR HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 08/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 E. LIBERTY STREET
COVINGTON IN
47932-1715
US

IV. Provider business mailing address

240 FENCL LANE
HILLSIDE IL
60162-2067
US

V. Phone/Fax

Practice location:
  • Phone: 765-793-4818
  • Fax: 765-793-5047
Mailing address:
  • Phone: 708-449-1900
  • Fax: 708-449-1500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number05-000128-1
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: JOHN HORNER
Title or Position: PRESIDENT & CEO
Credential:
Phone: 317-398-5255