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	05-000246-1	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871674556
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HENRY COUNTY MEMORIAL HOSPITAL

Provider Business Mailing Address
First Line	:	4600 W WASHINGTON ST
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46619-2320
Country	:	US
Telephone Number	:	574-282-1294
Fax Number	:	574-251-2260

Provider Business Practice Location Address
First Line	:	4600 W WASHINGTON ST
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46619
Country	:	US
Telephone Number	:	574-282-1294
Fax Number	:	574-251-2260

Authorized Official
Title or Position	:	CEO/PRESIDENT
Name	:	BRIAN RING
Credential	:
Telephone Number	:	765-521-1443

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	03/16/2026

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Directions to “HENRY COUNTY MEMORIAL HOSPITAL ” Practice Location

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