Healthcare Provider Details

I. General information

NPI: 1417991415
Provider Name (Legal Business Name): HANCOCK REGIONAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1332 WATERFORD CIR
GOSHEN IN
46526-6009
US

IV. Provider business mailing address

PO BOX 221648
LOUISVILLE KY
40252-1648
US

V. Phone/Fax

Practice location:
  • Phone: 574-534-3920
  • Fax: 574-534-7548
Mailing address:
  • Phone: 502-412-5847
  • Fax: 502-855-8708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number17-011150-1
License Number StateIN

VIII. Authorized Official

Name: STEVEN V. LONG
Title or Position: PRESIDENT & CEO
Credential:
Phone: 317-462-5544