Provider Demographics
NPI:1659300440
Name:HENDRICKS COUNTY HOSPITAL
Entity Type:Organization
Organization Name:HENDRICKS COUNTY HOSPITAL
Other - Org Name:HICKORY CREEK AT SUNSET
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:FENOUGHTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-745-3775
Mailing Address - Street 1:6081 E. 82ND ST.
Mailing Address - Street 2:SUITE 120
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-1562
Mailing Address - Country:US
Mailing Address - Phone:317-570-0266
Mailing Address - Fax:317-570-0488
Practice Address - Street 1:1109 S INDIANA ST
Practice Address - Street 2:
Practice Address - City:GREENCASTLE
Practice Address - State:IN
Practice Address - Zip Code:46135-1926
Practice Address - Country:US
Practice Address - Phone:765-653-3143
Practice Address - Fax:765-653-1651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05-000418-1314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100274870Medicaid
IN155565Medicare Oscar/Certification