Provider Demographics
NPI:1275703092
Name:HENDRICKS COUNTY HOSPITAL
Entity Type:Organization
Organization Name:HENDRICKS COUNTY HOSPITAL
Other - Org Name:BRICKYARD HEALTHCARE - PORTAGE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:P
Authorized Official - Last Name:SPEER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-745-4451
Mailing Address - Street 1:3175 LANCER ST
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:IN
Mailing Address - Zip Code:46368-4407
Mailing Address - Country:US
Mailing Address - Phone:219-762-9571
Mailing Address - Fax:
Practice Address - Street 1:3175 LANCER ST
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:IN
Practice Address - Zip Code:46368-4407
Practice Address - Country:US
Practice Address - Phone:219-762-9571
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100290980Medicaid
IN100290980Medicaid
CA155187Medicare Oscar/Certification