Healthcare Provider Details

I. General information

NPI: 1609952993
Provider Name (Legal Business Name): HANCOCK REGIONAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2006
Last Update Date: 02/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2695 SHELDON STREET
WARSAW IN
46582-0000
US

IV. Provider business mailing address

PO BOX 221648
LOUISVILLE KY
40252-1648
US

V. Phone/Fax

Practice location:
  • Phone: 574-658-9455
  • Fax: 574-658-3731
Mailing address:
  • Phone: 502-412-5841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number060004911
License Number StateIN

VIII. Authorized Official

Name: MR. STEVE V. LONG
Title or Position: PRESIDENT / CEO
Credential:
Phone: 317-468-4412