Healthcare Provider Details

I. General information

NPI: 1801871082
Provider Name (Legal Business Name): HENRY COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2005
Last Update Date: 08/26/2024
Certification Date: 09/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 N JACKSON STREET
OAKLAND CITY IN
47660-0010
US

IV. Provider business mailing address

231 N JACKSON STREET
OAKLAND CITY IN
47660-0010
US

V. Phone/Fax

Practice location:
  • Phone: 812-749-4774
  • Fax: 812-749-6396
Mailing address:
  • Phone: 812-749-4774
  • Fax: 812-749-6396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number10-000327-1
License Number StateIN

VIII. Authorized Official

Name: MR. STEVE VAN CAMP
Title or Position: CEO OF ASC
Credential: CPA
Phone: 317-788-2500