Organization
MAJOR HOSPITAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN M HORNER (CHIEF EXECUTIVE OFFICER)
(317) 392-3211
Entity
Organization
Contact information
Practice address
5025 MCCOOK AVE, EAST CHICAGO, IN 46312
(219) 397-0380
(219) 397-0668
Mailing address
5025 MCCOOK AVE, EAST CHICAGO, IN 46312-3759
(219) 397-0380
(219) 397-0668
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
05-000108-1
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100267410B
—
IN
01
—
155653
PTAN
—
Enumeration date
03/22/2007
Last updated
05/21/2018
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