=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831589498
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HANCOCK REGIONAL HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/03/2015
-----------------------------------------------------
Last Update Date | 10/04/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14751 CAREY RD
-----------------------------------------------------
City | CARMEL
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46033-9084
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-575-2208
-----------------------------------------------------
Fax | 317-575-6102
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14751 CAREY RD
-----------------------------------------------------
City | CARMEL
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46033-9084
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-575-2208
-----------------------------------------------------
Fax | 317-575-6102
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CEO
-----------------------------------------------------
Name | STEVEN V LONG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 317-462-5544
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 15-012548-1
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------