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Organization
PULASKI MEMORIAL HOSPITAL
Active
Organization
PULASKI MEMORIAL HOSPITAL
Active
Other names
Maple Manor Christian Home
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GREGG A. MALOTT (DIRECTOR OF BUSINESS DEVELOPMENT)
(574) 946-2100
Entity
Organization
Contact information
Practice address
643 WEST UTICA STREET, SELLERSBURG, IN 47172-1163
(812) 246-4866
(821) 246-3925
Mailing address
643 WEST UTICA STREET, SELLERSBURG, IN 47172-1163
(812) 246-4866
(821) 246-3925
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
05-00056301
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000556877
BLUE CROSS BLUE SHIELD
IN
05
—
100267610 A
—
IN
Enumeration date
10/21/2005
Last updated
07/16/2019
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