Provider Demographics
NPI:1821334483
Name:HENRY COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:HENRY COUNTY MEMORIAL HOSPITAL
Other - Org Name:MULBERRY HEALTH & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-521-1515
Mailing Address - Street 1:502 W JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:MULBERRY
Mailing Address - State:IN
Mailing Address - Zip Code:46058-9538
Mailing Address - Country:US
Mailing Address - Phone:765-296-2911
Mailing Address - Fax:765-296-9516
Practice Address - Street 1:502 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:MULBERRY
Practice Address - State:IN
Practice Address - Zip Code:46058-9538
Practice Address - Country:US
Practice Address - Phone:765-296-2911
Practice Address - Fax:765-296-9516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-28
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN155600Medicare Oscar/Certification