Organization
FAYETTE MEMORIAL HOSPITAL ASSOCIATION INC
Active
Other names
Fayette Regional Care Pavillion
Organization subpart
No
Provider details
NPI number
Authorized official
RANDALL WHITE (CEO)
(765) 827-7987
Entity
Organization
Contact information
Practice address
450 ERIE AVE, CONNERSVILLE, IN 47331-3176
(765) 827-7890
(765) 825-6628
Mailing address
1941 VIRGINIA AVE, CONNERSVILLE, IN 47331-2833
(765) 827-8933
(765) 827-7863
Taxonomy
Speciality
Code
Description
License number
State
323P00000X
Psychiatric Residential Treatment Facility
Primary
7352421900926
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100415070A
—
IN
05
—
200406860A
—
IN
Enumeration date
03/18/2006
Last updated
03/23/2016
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