Provider Demographics
NPI:1093875221
Name:THE HEALTH AND HOSPITAL CORPORATION OF MARION COUNTY
Entity Type:Organization
Organization Name:THE HEALTH AND HOSPITAL CORPORATION OF MARION COUNTY
Other - Org Name:ROSEBUD VILLAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO OF ASC
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN CAMP
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:317-788-2500
Mailing Address - Street 1:2050 CHESTER BLVD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1215
Mailing Address - Country:US
Mailing Address - Phone:765-935-4440
Mailing Address - Fax:765-935-0054
Practice Address - Street 1:2050 CHESTER BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374
Practice Address - Country:US
Practice Address - Phone:765-935-4440
Practice Address - Fax:765-935-0054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN060001351314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100266820CMedicaid
IN155230Medicare Oscar/Certification