Healthcare Provider Details

I. General information

NPI: 1285729673
Provider Name (Legal Business Name): MAJOR HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 09/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W 87TH AVE
MERRILLVILLE IN
46410-6177
US

IV. Provider business mailing address

2201 MAIN ST
EVANSTON IL
60202-1519
US

V. Phone/Fax

Practice location:
  • Phone: 219-756-0744
  • Fax:
Mailing address:
  • Phone: 847-905-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number06-010739-1
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateIN

VIII. Authorized Official

Name: JOHN MARK HORNER
Title or Position: PRESIDENT & CEO
Credential:
Phone: 317-398-5252