Healthcare Provider Details

I. General information

NPI: 1710934518
Provider Name (Legal Business Name): HENDRICKS COUNTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 11/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 N 075 E
LAGRANGE IN
46761-9359
US

IV. Provider business mailing address

3001 KEITH ST NW
CLEVELAND TN
37312-3713
US

V. Phone/Fax

Practice location:
  • Phone: 260-463-7445
  • Fax: 260-463-7282
Mailing address:
  • Phone: 423-473-5751
  • Fax: 423-339-8342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number040002351
License Number StateIN

VIII. Authorized Official

Name: KEVIN SPEER
Title or Position: CEO
Credential:
Phone: 317-745-3500