Organization
PULASKI MEMORIAL HOSPITAL
Active
Other names
Maple Manor Christian Home
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GREGG A. MALOTT (DIRECTOR OF BUSINESS DEVELOPMENT)
(574) 946-2100
Entity
Organization
Contact information
Practice address
643 WEST UTICA STREET, SELLERSBURG, IN 47172-1163
(812) 246-4866
(821) 246-3925
Mailing address
643 WEST UTICA STREET, SELLERSBURG, IN 47172-1163
(812) 246-4866
(821) 246-3925
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
05-00056301
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000556877
BLUE CROSS BLUE SHIELD
IN
05
—
100267610 A
—
IN
Enumeration date
10/21/2005
Last updated
07/16/2019
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