Healthcare Provider Details

I. General information

NPI: 1760257968
Provider Name (Legal Business Name): NW INDIANA-AMG SPECIALTY HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2023
Last Update Date: 11/17/2023
Certification Date: 11/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9509 GEORGIA ST
CROWN POINT IN
46307-6518
US

IV. Provider business mailing address

101 LA RUE FRANCE STE 500
LAFAYETTE LA
70508-3144
US

V. Phone/Fax

Practice location:
  • Phone: 219-472-2200
  • Fax: 219-472-2147
Mailing address:
  • Phone: 337-269-9566
  • Fax: 337-269-9823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: MS. JESSICA LANE MCGEE
Title or Position: CFO
Credential:
Phone: 337-269-9566