Healthcare Provider Details

I. General information

NPI: 1003853557
Provider Name (Legal Business Name): HENRY COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 08/16/2022
Certification Date: 08/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 CHATEAU DR
MUNCIE IN
47303-1900
US

IV. Provider business mailing address

2400 CHATEAU DR
MUNCIE IN
47303-1900
US

V. Phone/Fax

Practice location:
  • Phone: 765-747-9044
  • Fax: 765-747-4954
Mailing address:
  • Phone: 765-747-9044
  • Fax: 765-747-4954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number13-000310-1
License Number StateIN

VIII. Authorized Official

Name: MR. BRIAN RING
Title or Position: PRESIDENT/CEO
Credential:
Phone: 765-521-1515