Healthcare Provider Details

I. General information

NPI: 1952659757
Provider Name (Legal Business Name): HENRY COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2012
Last Update Date: 08/17/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8530 TOWNSHIP LINE RD
INDIANAPOLIS IN
46260-1927
US

IV. Provider business mailing address

8530 TOWNSHIP LINE RD
INDIANAPOLIS IN
46260-1927
US

V. Phone/Fax

Practice location:
  • Phone: 317-876-9955
  • Fax: 317-876-6016
Mailing address:
  • Phone: 317-876-9955
  • Fax: 317-876-6016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: CAROL SPARKS
Title or Position: DIRECTOR OF REIMBURSEMENT
Credential:
Phone: 949-349-1200