Provider Demographics
NPI:1902920069
Name:ADAMS COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:ADAMS COUNTY MEMORIAL HOSPITAL
Other - Org Name:ENVIVE OF LAWRENCEBURG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SPRUNGER
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:260-724-2145
Mailing Address - Street 1:1100 MERCER AVENUE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IN
Mailing Address - Zip Code:46733-2303
Mailing Address - Country:US
Mailing Address - Phone:260-724-2145
Mailing Address - Fax:317-818-1022
Practice Address - Street 1:403 BIELBY ROAD
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:IN
Practice Address - Zip Code:47025-1003
Practice Address - Country:US
Practice Address - Phone:812-537-1132
Practice Address - Fax:812-537-4636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11-000022-1314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100274510BMedicaid
IN100274510BMedicaid