Provider Demographics
NPI:1407847361
Name:MAJOR HOSPITAL
Entity Type:Organization
Organization Name:MAJOR HOSPITAL
Other - Org Name:WALDRON HEALTH AND REHAB CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HORNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-398-5252
Mailing Address - Street 1:505 N MAIN ST
Mailing Address - Street 2:PO BOX 399
Mailing Address - City:WALDRON
Mailing Address - State:IN
Mailing Address - Zip Code:46182-9791
Mailing Address - Country:US
Mailing Address - Phone:765-525-4371
Mailing Address - Fax:765-525-4246
Practice Address - Street 1:505 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WALDRON
Practice Address - State:IN
Practice Address - Zip Code:46182-9791
Practice Address - Country:US
Practice Address - Phone:765-525-4371
Practice Address - Fax:765-525-4246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN050004231314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100290450AMedicaid
155704Medicare Oscar/Certification