Healthcare Provider Details

I. General information

NPI: 1760472252
Provider Name (Legal Business Name): HENRY COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3518 S SHELBY ST
INDIANAPOLIS IN
46227-3226
US

IV. Provider business mailing address

3518 S SHELBY ST
INDIANAPOLIS IN
46227-3226
US

V. Phone/Fax

Practice location:
  • Phone: 317-783-4042
  • Fax: 317-781-3044
Mailing address:
  • Phone: 317-783-4042
  • Fax: 317-781-3044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number10-000142-1
License Number StateIN

VIII. Authorized Official

Name: MR. STEVE VAN CAMP
Title or Position: CFO OF ASC
Credential: CPA
Phone: 317-788-2500