Healthcare Provider Details

I. General information

NPI: 1487044822
Provider Name (Legal Business Name): PULASKI MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2015
Last Update Date: 02/01/2024
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5024 WESTERN AVE.
SOUTH BEND IN
46619-2312
US

IV. Provider business mailing address

5024 WESTERN AVE.
SOUTH BEND IN
46619-2312
US

V. Phone/Fax

Practice location:
  • Phone: 574-318-4600
  • Fax: 574-400-0619
Mailing address:
  • Phone: 574-318-4600
  • Fax: 574-400-0619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: GREGG A MALOTT
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 574-946-2103