Healthcare Provider Details

I. General information

NPI: 1114930104
Provider Name (Legal Business Name): MAJOR HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 W MATADOR ST
PERU IN
46970-3711
US

IV. Provider business mailing address

1850 W MATADOR ST
PERU IN
46970-3711
US

V. Phone/Fax

Practice location:
  • Phone: 765-689-5000
  • Fax: 765-689-5711
Mailing address:
  • Phone: 765-689-5000
  • Fax: 765-689-5711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number003130
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number14-003130-1
License Number StateIN

VIII. Authorized Official

Name: RYAN CLAXTON
Title or Position: PRESIDENT/CEO
Credential:
Phone: 317-392-3211