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	314000000X	Skilled Nursing Facility	12-000133-1	IN

General Provider Information

NPI Number	:	1306117197
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HENRY COUNTY MEMORIAL HOSPITAL

Provider Business Mailing Address
First Line	:	2070 CHESTER BLVD
Second Line	:
City	:	RICHMOND
State	:	IN
Zip	:	47374-1215
Country	:	US
Telephone Number	:	765-962-3543
Fax Number	:	765-935-5060

Provider Business Practice Location Address
First Line	:	2070 CHESTER BLVD
Second Line	:
City	:	RICHMOND
State	:	IN
Zip	:	47374-1215
Country	:	US
Telephone Number	:	765-962-3543
Fax Number	:	765-935-5060

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	BRIAN RING
Credential	:
Telephone Number	:	765-521-1515

Provider Enumeration Date	:	01/25/2012
Last Update Date	:	07/28/2023

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