Provider Demographics
NPI:1609952993
Name:HANCOCK REGIONAL HOSPITAL
Entity Type:Organization
Organization Name:HANCOCK REGIONAL HOSPITAL
Other - Org Name:PADDOCK SPRINGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:V
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-468-4412
Mailing Address - Street 1:PO BOX 221648
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40252-1648
Mailing Address - Country:US
Mailing Address - Phone:502-412-5841
Mailing Address - Fax:
Practice Address - Street 1:2695 SHELDON STREET
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46582-0000
Practice Address - Country:US
Practice Address - Phone:574-658-9455
Practice Address - Fax:574-658-3731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-29
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN060004911314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100291230BMedicaid
IN200308930AMedicaid
155495AMedicare Oscar/Certification
155495Medicare Oscar/Certification