Provider Demographics
NPI:1982729604
Name:ADAMS COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:ADAMS COUNTY MEMORIAL HOSPITAL
Other - Org Name:SILVER MEMORIES HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DANE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:260-724-7145
Mailing Address - Street 1:PO BOX 151
Mailing Address - Street 2:1100 MERCER AVENUE
Mailing Address - City:DECATUR
Mailing Address - State:IN
Mailing Address - Zip Code:46733-2303
Mailing Address - Country:US
Mailing Address - Phone:260-724-2145
Mailing Address - Fax:260-728-3852
Practice Address - Street 1:6996 S US 421
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:IN
Practice Address - Zip Code:47042-9390
Practice Address - Country:US
Practice Address - Phone:812-689-6222
Practice Address - Fax:812-689-7443
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADAMS COUNTY MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-20
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN15E657313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100273470Medicaid
IN155847Medicare Oscar/Certification