Hickory Creek Healthcare Foundation, Inc.

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

License

05-000614-1 Issued in IN

Legal business name

HICKORY CREEK HEALTHCARE FOUNDATION, INC.

Doing business as

Hickory Creek at Gaston

Practice address

502 N. Madison St
Gaston, IN 47342-0159

Phone

(765) 358-3324

Fax

(765) 358-4365

NPI assigned

Jul 5, 2006

Last updated

Sep 26, 2013By the provider in NPPES

Organization subpart

Yes

Parent organization

HICKORY CREEK HEALTHCARE FOUNDATION INCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Gary Brent Waymire

Title

Vice President of Operations

Phone

(317) 570-0266

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Hickory Creek at Gaston Doing business as

Tax ID family

Hickory Creek Healthcare Foundation Inc2 organizations share this tax ID, including this one

Part of

Hickory Creek Healthcare Foundation Inc

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Hickory Creek Healthcare Foundation, Inc.

  dba Hickory Creek at Lebanon

  • Skilled Nursing Facility
  • Lebanon, IN
  • NPI 1740214493
  NPD tax ID

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Hickory Creek Healthcare Foundation, Inc.

  dba Hickory Creek at Lebanon

  • Skilled Nursing Facility
  • Lebanon, IN
  • NPI 1740214493
  NPPES parent name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1380153600000",
    "number": "1265463665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6081 E 82ND ST",
            "address_2": "SUITE 120",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462501795",
            "telephone_number": "317-570-0266",
            "fax_number": "317-570-0488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "502 N. MADISON ST",
            "city": "GASTON",
            "state": "IN",
            "postal_code": "473420159",
            "telephone_number": "765-358-3324",
            "fax_number": "765-358-4365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HICKORY CREEK HEALTHCARE FOUNDATION, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HICKORY CREEK HEALTHCARE FOUNDATION INC",
        "enumeration_date": "2006-07-05",
        "last_updated": "2013-09-26",
        "status": "A",
        "authorized_official_last_name": "WAYMIRE",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "BRENT",
        "authorized_official_title_or_position": "VICE PRESIDENT OF OPERATIONS",
        "authorized_official_telephone_number": "317-570-0266",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "IN",
            "license": "05-000614-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100272120",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hickory Creek at Gaston",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Darin Lance Barnes
• Gaston Volunteer Fire Dept, Inc
• Reva Hodge, EDD
• Dawn M Jeffers, M.S.,R.D.,C.D
• Makayla Rose Johnson
• Gemma E Smith, MA, CCC-SLP
• Wes-del Community Schools

• Intellectual Disabilities Intermediate Care Facility in Gaston, IN
• Providers in Gaston, IN by specialty
• Intellectual Disabilities Intermediate Care Facility in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.