MEDICARE: HENRY COUNTY MEMORIAL HOSPITAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1205441854
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HENRY COUNTY MEMORIAL HOSPITAL

Provider Business Mailing Address
First Line	:	3530 S SHELBY ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-3269
Country	:	US
Telephone Number	:	317-784-3066
Fax Number	:	317-781-3037

Provider Business Practice Location Address
First Line	:	3530 S SHELBY ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-3269
Country	:	US
Telephone Number	:	317-784-3066
Fax Number	:	317-781-3037

Authorized Official
Title or Position	:	CFO OF ASC
Name	:	MR. STEVE VAN CAMP
Credential	:	CPA
Telephone Number	:	317-788-2500

Provider Enumeration Date	:	09/10/2020
Last Update Date	:	05/31/2024

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Directions to “HENRY COUNTY MEMORIAL HOSPITAL ” Practice Location

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