Provider Demographics
NPI:1790772382
Name:MAJOR HOSPITAL
Entity Type:Organization
Organization Name:MAJOR HOSPITAL
Other - Org Name:HEALTHCARE CENTER AT WITTENBERG VILLAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HORNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-421-2012
Mailing Address - Street 1:1200 LUTHER DR
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-5043
Mailing Address - Country:US
Mailing Address - Phone:219-663-3860
Mailing Address - Fax:219-661-8431
Practice Address - Street 1:1200 LUTHER DR
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-5043
Practice Address - Country:US
Practice Address - Phone:219-663-3860
Practice Address - Fax:219-661-8431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-29
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0500005151314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100290820Medicaid
IN155608Medicare Oscar/Certification