# PULASKI MEMORIAL HOSPITAL

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Maple Manor Christian Home
- **Organization subpart:** No

## Provider details

- **NPI number:** 1811987894
- **Authorized official:** MR. GREGG A. MALOTT (DIRECTOR OF BUSINESS DEVELOPMENT)
- **Authorized official phone:** (574) 946-2100

## Contact information

- **Practice address:** 643 WEST UTICA STREET, SELLERSBURG, IN 47172-1163
- **Practice address phone:** (812) 246-4866
- **Practice address fax:** (821) 246-3925
- **Mailing address:** 643 WEST UTICA STREET, SELLERSBURG, IN 47172-1163
- **Mailing address phone:** (812) 246-4866
- **Mailing address fax:** (821) 246-3925

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 05-00056301 | IN | Yes |

## Other

- **Enumeration date:** 10/21/2005
- **Last updated:** 07/16/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000000556877 | BLUE CROSS BLUE SHIELD | IN |
| 05 | — | 100267610 A | — | IN |