Provider Demographics
NPI:1205441854
Name:HENRY COUNTY MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:HENRY COUNTY MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO OF ASC
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN CAMP
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:317-788-2500
Mailing Address - Street 1:3530 S SHELBY ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-3269
Mailing Address - Country:US
Mailing Address - Phone:317-784-3066
Mailing Address - Fax:317-781-3037
Practice Address - Street 1:3530 S SHELBY ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-3269
Practice Address - Country:US
Practice Address - Phone:317-784-3066
Practice Address - Fax:317-781-3037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-10
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility