Healthcare Provider Details

I. General information

NPI: 1013358563
Provider Name (Legal Business Name): HANCOCK REGIONAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2013
Last Update Date: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5226 E 82ND ST
INDIANAPOLIS IN
46250-1628
US

IV. Provider business mailing address

5226 E 82ND ST
INDIANAPOLIS IN
46250-1628
US

V. Phone/Fax

Practice location:
  • Phone: 317-842-6668
  • Fax: 317-578-4113
Mailing address:
  • Phone: 317-842-6668
  • Fax: 317-578-4113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number130001721
License Number StateIN

VIII. Authorized Official

Name: STEVEN LONG
Title or Position: PRESIDENT/CEO
Credential:
Phone: 317-462-5544