Provider Demographics
NPI:1821040031
Name:HENDRICKS COUNTY HOSPITAL
Entity Type:Organization
Organization Name:HENDRICKS COUNTY HOSPITAL
Other - Org Name:BRICKYARD HEALTHCARE - BLOOMINGTON CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:P
Authorized Official - Last Name:SPEER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-745-4451
Mailing Address - Street 1:155 E BURKS DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-8459
Mailing Address - Country:US
Mailing Address - Phone:812-332-4437
Mailing Address - Fax:812-335-3672
Practice Address - Street 1:155 E BURKS DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-8459
Practice Address - Country:US
Practice Address - Phone:812-332-4437
Practice Address - Fax:812-335-3672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06-000177-1314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1002 89860-BMedicaid
IN100289860Medicaid
IN155278Medicare Oscar/Certification
CA155278Medicare Oscar/Certification