Healthcare Provider Details

I. General information

NPI: 1164451944
Provider Name (Legal Business Name): HENRY COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 08/16/2022
Certification Date: 08/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 BOULEVARD
PERU IN
46970-1514
US

IV. Provider business mailing address

6081 E 82ND ST
INDIANAPOLIS IN
46250-1795
US

V. Phone/Fax

Practice location:
  • Phone: 765-473-4900
  • Fax: 765-473-3196
Mailing address:
  • Phone: 317-570-0266
  • Fax: 317-570-0266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number06-000475-1
License Number StateIN

VIII. Authorized Official

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