Healthcare Provider Details

I. General information

NPI: 1194940205
Provider Name (Legal Business Name): HENDRICKS COUNTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 04/26/2021
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1661 BEACON ST.
FORT WAYNE IN
46805-9563
US

IV. Provider business mailing address

1661 BEACON ST.
FORT WAYNE IN
46805-9563
US

V. Phone/Fax

Practice location:
  • Phone: 260-637-3166
  • Fax:
Mailing address:
  • Phone: 260-637-3166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number000255
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number000255
License Number StateIN

VIII. Authorized Official

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