# HENRY COUNTY MEMORIAL HOSPITAL

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- **Entity:** Organization
- **Status:** Active
- **Other names:** The Waters of Muncie
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003853557
- **Authorized official:** MR. BRIAN RING (PRESIDENT/CEO)
- **Authorized official phone:** (765) 521-1515

## Contact information

- **Practice address:** 2400 CHATEAU DR, MUNCIE, IN 47303-1900
- **Practice address phone:** (765) 747-9044
- **Practice address fax:** (765) 747-4954
- **Mailing address:** 2400 CHATEAU DR, MUNCIE, IN 47303-1900
- **Mailing address phone:** (765) 747-9044
- **Mailing address fax:** (765) 747-4954

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 13-000310-1 | IN | Yes |

## Other

- **Enumeration date:** 06/01/2006
- **Last updated:** 08/16/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000000381419 | ANTHEM BCBS | IN |
| 01 | — | 000000391194 | ANTHEM PT | IN |
| 01 | — | 000000391195 | ANTHEM ST | IN |
| 05 | — | 100288970C | — | IN |
| 01 | — | 5586760001 | DMERC REGION B SUPPLIER\# | IN |