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General NPI Number Information
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NPI Number | 1649279258
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Entity Type | Organization
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Legal Business Name | HENRY COUNTY MEMORIAL HOSPITAL
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Dates
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Enumeration Date | 07/15/2005
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Last Update Date | 06/14/2023
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Provider Practice Location Address
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Address Line | 281 SOUTH COUNTY ROAD 200 EAST
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City | CONNERSVILLE
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State | IN
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Zip | 47331-8220
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Country | US
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Telephone | 765-825-2148
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Fax | 765-827-5926
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Provider Business Mailing Address
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Address Line | 281 SOUTH COUNTY ROAD 200 EAST
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City | CONNERSVILLE
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State | IN
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Zip | 47331-8220
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Country | US
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Telephone | 765-825-2148
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Fax | 765-827-5926
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Authorized Official
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Title or Position | CFO OF ASC
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Name | MR. STEVE VAN CAMP
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Credential | CPA
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Telephone | 317-788-2500
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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 | 352138501
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License Number State | IN
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