Provider Demographics
NPI:1336289867
Name:HENRY COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:HENRY COUNTY MEMORIAL HOSPITAL
Other - Org Name:CLINTON HOUSE HEALTH AND REHAB CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:
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 1:809 W FREEMAN ST
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IN
Mailing Address - Zip Code:46041-2944
Mailing Address - Country:US
Mailing Address - Phone:765-654-8783
Mailing Address - Fax:765-659-0527
Practice Address - Street 1:809 W FREEMAN ST
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IN
Practice Address - Zip Code:46041-2944
Practice Address - Country:US
Practice Address - Phone:765-654-8783
Practice Address - Fax:765-659-0527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN14-000192-1314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100291120Medicaid
155295Medicare Oscar/Certification