Healthcare Provider Details

I. General information

NPI: 1093736076
Provider Name (Legal Business Name): PULASKI MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 09/26/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 W. POPLAR ST.
GREENCASTLE IN
46135-1636
US

IV. Provider business mailing address

102 W. POPLAR ST.
GREENCASTLE IN
46135-1636
US

V. Phone/Fax

Practice location:
  • Phone: 765-653-5148
  • Fax: 765-653-5587
Mailing address:
  • Phone: 765-653-5148
  • Fax: 765-653-5587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number001120
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number001120
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: GREGG A MALOTT
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 574-946-2103