Provider Demographics
NPI:1730120213
Name:MAJOR HOSPITAL
Entity Type:Organization
Organization Name:MAJOR HOSPITAL
Other - Org Name:THE WATERS OF DILLSBORO-ROSS MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HORNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-398-5255
Mailing Address - Street 1:240 FENCL LANE
Mailing Address - Street 2:
Mailing Address - City:HILLSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60162-2067
Mailing Address - Country:US
Mailing Address - Phone:708-449-1900
Mailing Address - Fax:708-449-1500
Practice Address - Street 1:12803 LENOVER ST
Practice Address - Street 2:
Practice Address - City:DILLSBORO
Practice Address - State:IN
Practice Address - Zip Code:47018-9418
Practice Address - Country:US
Practice Address - Phone:812-432-5226
Practice Address - Fax:812-432-3311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05-000178-1314000000X
314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100273840CMedicaid
IN000000385604OtherANTHEM BCBS OT OUTPATIENT
IN000000383032OtherANTHEM BCBS
IN000000385605OtherANTHEM BCBS ST OUTPATIENT
IN000000385603OtherANTHEM BCBS PT OUTPATIENT
IN000000383032OtherANTHEM BCBS
IN5586630001Medicare NSC
IN000000385604OtherANTHEM BCBS OT OUTPATIENT