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General NPI Number Information
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NPI Number | 1194167650
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Entity Type | Organization
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Legal Business Name | PULASKI MEMORIAL HOSPITAL
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Dates
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Enumeration Date | 07/25/2013
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Last Update Date | 01/18/2022
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Provider Practice Location Address
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Address Line | 206 E MARION ST
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City | SOUTH BEND
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State | IN
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Zip | 46601-1029
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Country | US
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Telephone | 574-233-0165
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Fax | 574-237-9818
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Provider Business Mailing Address
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Address Line | 206 E MARION ST
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City | SOUTH BEND
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State | IN
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Zip | 46601-1029
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Country | US
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Telephone | 574-233-0165
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Fax | 574-237-9818
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Authorized Official
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Title or Position | MANAGER
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Name | PHILIP MONROE MEYER
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Credential |
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Telephone | 423-834-1494
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 12-001141-1
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License Number State | IN
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