Hickory Creek Healthcare Foundation, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

1289N Issued in OH

Legal business name

HICKORY CREEK HEALTHCARE FOUNDATION, INC.

Doing business as

Hickory Creek at Hicksville

Practice address

401 Fountain St
Hicksville, OH 43526-1337

Phone

(419) 542-7795

Fax

(419) 542-9765

NPI assigned

Jul 2, 2006

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 Hicksville Doing business as

Part of

Hickory Creek Healthcare Foundation Inc

Locations

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

{
    "created_epoch": "1151798400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1380153600000",
    "number": "1679502439",
    "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": "401 FOUNTAIN ST",
            "city": "HICKSVILLE",
            "state": "OH",
            "postal_code": "435261337",
            "telephone_number": "419-542-7795",
            "fax_number": "419-542-9765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HICKORY CREEK HEALTHCARE FOUNDATION, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HICKORY CREEK HEALTHCARE FOUNDATION INC",
        "enumeration_date": "2006-07-02",
        "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": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "OH",
            "license": "1289N",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2324934",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hickory Creek at Hicksville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Matthew C Grothaus, M.D.
• Ashley Guilford, R.D.
• Johnathan Robert Haggerty, D.C.
• Cory T Hammond, PA
• Craig Eugene Hanson, M.D.
• Hicksville Exempted Village Schools
• Hicksville Family Eye Care LLC
• Hicksville Pharmacy & Home Medical Inc
• Andrew David Hoffman, O.D.
• Samantha Jo Kimpel

• Skilled Nursing Facility in Hicksville, OH
• Providers in Hicksville, OH by specialty
• Skilled Nursing Facility in Ohio

• 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.