Healthcare Provider Details

I. General information

NPI: 1861833311
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: 10/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4102 SHORE DR
INDIANAPOLIS IN
46254-2608
US

IV. Provider business mailing address

4102 SHORE DR
INDIANAPOLIS IN
46254-2608
US

V. Phone/Fax

Practice location:
  • Phone: 317-347-9051
  • Fax: 317-347-9605
Mailing address:
  • Phone: 317-347-9051
  • Fax: 317-347-9605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number130106662
License Number StateIN

VIII. Authorized Official

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