Provider Demographics
NPI:1760519268
Name:ADAMS COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:ADAMS COUNTY MEMORIAL HOSPITAL
Other - Org Name:ADAMS HERITAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANE
Authorized Official - Middle Name:E
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:260-724-2145
Mailing Address - Street 1:12011 WHITTERN RD
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46773-9126
Mailing Address - Country:US
Mailing Address - Phone:260-623-6440
Mailing Address - Fax:260-623-6870
Practice Address - Street 1:12011 WHITTERN RD
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:IN
Practice Address - Zip Code:46773-9126
Practice Address - Country:US
Practice Address - Phone:260-623-6440
Practice Address - Fax:260-623-6870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN060025491313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200289420AMedicaid
IN200289420AMedicaid