Provider Demographics
NPI:1467509463
Name:MAJOR HOSPITAL
Entity Type:Organization
Organization Name:MAJOR HOSPITAL
Other - Org Name:CORE OF DALE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
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 1:510 W MEDCALF
Mailing Address - Street 2:P.O. BOX 325
Mailing Address - City:DALE
Mailing Address - State:IN
Mailing Address - Zip Code:47523-0325
Mailing Address - Country:US
Mailing Address - Phone:812-937-7073
Mailing Address - Fax:812-254-6350
Practice Address - Street 1:510 W MEDCALF
Practice Address - Street 2:BOX 325
Practice Address - City:DALE
Practice Address - State:IN
Practice Address - Zip Code:47523-0325
Practice Address - Country:US
Practice Address - Phone:812-937-7073
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07-000170-1314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100287490CMedicaid
IN1467509463Medicare NSC
IN155270Medicare Oscar/Certification