Provider Demographics
NPI:1417398199
Name:JACKSON COUNTY SCHNECK MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:JACKSON COUNTY SCHNECK MEMORIAL HOSPITAL
Other - Org Name:MAJESTIC CARE OF LAFAYETTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:DUANE
Authorized Official - Last Name:FISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-523-5864
Mailing Address - Street 1:300 WINDY HILL DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-2862
Mailing Address - Country:US
Mailing Address - Phone:765-477-7791
Mailing Address - Fax:765-474-6083
Practice Address - Street 1:300 WINDY HILL DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-2862
Practice Address - Country:US
Practice Address - Phone:765-477-7791
Practice Address - Fax:765-474-6083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-10
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100266900CMedicaid
155243Medicare Oscar/Certification