# HENRY COUNTY MEMORIAL HOSPITAL

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Fairway Village
- **Organization subpart:** No

## Provider details

- **NPI number:** 1952452815
- **Authorized official:** STEVEN VANCAMP (CEO OF ASC)
- **Authorized official phone:** (317) 788-2500

## Contact information

- **Practice address:** 2630 S KEYSTONE AVE, INDIANAPOLIS, IN 46203
- **Practice address phone:** (317) 787-8951
- **Practice address fax:** (317) 780-2550
- **Mailing address:** 2630 S KEYSTONE AVE, INDIANAPOLIS, IN 46203-5563
- **Mailing address phone:** (317) 787-8951
- **Mailing address fax:** (317) 780-2550

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 06-004700-1 | IN | Yes |

## Other

- **Enumeration date:** 01/16/2007
- **Last updated:** 06/25/2026

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100266630C | — | IN |