Organization
HICKORY CREEK HEALTHCARE FOUNDATION, INC.
Active
Parent organization
HICKORY CREEK HEALTHCARE FOUNDATION INC
Other names
Hickory Creek at Gaston
Organization subpart
Yes
Provider details
NPI number
Legal business name
HICKORY CREEK HEALTHCARE FOUNDATION INC
Authorized official
MR. GARY BRENT WAYMIRE (VICE PRESIDENT OF OPERATIONS)
(317) 570-0266
Entity
Organization
Contact information
Practice address
502 N. MADISON ST, GASTON, IN 47342-0159
(765) 358-3324
(765) 358-4365
Mailing address
6081 E 82ND ST, SUITE 120, INDIANAPOLIS, IN 46250-1795
(317) 570-0266
(317) 570-0488
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
05-000614-1
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100272120
—
IN
Enumeration date
07/05/2006
Last updated
09/26/2013
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