Healthcare Provider Details

I. General information

NPI: 1376965269
Provider Name (Legal Business Name): HANCOCK REGIONAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2014
Last Update Date: 10/06/2022
Certification Date: 10/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 E 16TH ST
INDIANAPOLIS IN
46219-2308
US

IV. Provider business mailing address

7301 E 16TH ST
INDIANAPOLIS IN
46219-2308
US

V. Phone/Fax

Practice location:
  • Phone: 317-353-1290
  • Fax: 317-351-2579
Mailing address:
  • Phone: 317-353-1290
  • Fax: 317-351-2579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number14-000227-1
License Number StateIN

VIII. Authorized Official

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