Organization
HICKORY CREEK HEALTHCARE FOUNDATION, INC.
Active
Parent organization
HICKORY CREEK HEALTHCARE FOUNDATION INC
Other names
Hickory Creek at Hicksville
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
401 FOUNTAIN ST, HICKSVILLE, OH 43526-1337
(419) 542-7795
(419) 542-9765
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
314000000X
Skilled Nursing Facility
Primary
1289N
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2324934
—
OH
Enumeration date
07/02/2006
Last updated
09/26/2013
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