Provider Demographics
NPI:1003853557
Name:HENRY COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:HENRY COUNTY MEMORIAL HOSPITAL
Other - Org Name:THE WATERS OF MUNCIE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-521-1515
Mailing Address - Street 1:2400 CHATEAU DR
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-1900
Mailing Address - Country:US
Mailing Address - Phone:765-747-9044
Mailing Address - Fax:765-747-4954
Practice Address - Street 1:2400 CHATEAU DR
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-1900
Practice Address - Country:US
Practice Address - Phone:765-747-9044
Practice Address - Fax:765-747-4954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN13-000310-1314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000381419OtherANTHEM BCBS
IN000000391195OtherANTHEM ST
IN5586760001OtherDMERC REGION B SUPPLIER#
IN000000391194OtherANTHEM PT
IN100288970CMedicaid
IN5586760001OtherDMERC REGION B SUPPLIER#
IN100288970CMedicaid