Organization
PULASKI MEMORIAL HOSPITAL
Active
Other names
Kingston Care Center of Fort Wayne, Kingston Health Center of Fort Wayne
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GREGG A MALOTT (CHIEF FINANCIAL OFFICER)
(574) 946-2103
Entity
Organization
Contact information
Practice address
1010 W WASHINGTON CENTER RD., FORT WAYNE, IN 46825
(260) 489-2552
(419) 247-2872
Mailing address
1010 W WASHINGTON CENTER RD., FORT WAYNE, IN 46825
(260) 489-2552
(419) 247-2872
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
05-000522-1
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000204329
ANTHEM
IN
05
—
100267040
—
IN
05
—
100267040A
—
IN
Enumeration date
10/03/2005
Last updated
04/15/2026
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