Provider Demographics
NPI:1508803099
Name:HENDRICKS COUNTY HOSPITAL
Entity Type:Organization
Organization Name:HENDRICKS COUNTY HOSPITAL
Other - Org Name:PLAINFIELD HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
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 1:3700 CLARKS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-1925
Mailing Address - Country:US
Mailing Address - Phone:317-839-6577
Mailing Address - Fax:
Practice Address - Street 1:3700 CLARKS CREEK RD
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46168-1925
Practice Address - Country:US
Practice Address - Phone:317-839-6577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0113563841-003314000000X, 332BN1400X, 332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100290940CMedicaid
IN5863470001Medicare NSC
TN5863470001Medicare NSC
IN155215Medicare Oscar/Certification