Provider Demographics
NPI:1215045000
Name:HANCOCK REGIONAL HOSPITAL
Entity Type:Organization
Organization Name:HANCOCK REGIONAL HOSPITAL
Other - Org Name:BETHANY POINTE HEALTH CAMPUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-462-5544
Mailing Address - Street 1:PO BOX 221648
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40252-1648
Mailing Address - Country:US
Mailing Address - Phone:502-412-5847
Mailing Address - Fax:
Practice Address - Street 1:1707 BETHANY RD
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46012-9669
Practice Address - Country:US
Practice Address - Phone:765-822-1211
Practice Address - Fax:765-822-1214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06-011045-1314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200380790AMedicaid
155698Medicare Oscar/Certification
IN155698Medicare ID - Type Unspecified