Healthcare Provider Details

I. General information

NPI: 1407959059
Provider Name (Legal Business Name): ADAMS COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 05/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 N INDIANA AVE
CROWN POINT IN
46307-4112
US

IV. Provider business mailing address

1100 MERCER AVE PO BOX 151
DECATUR IN
46733-2303
US

V. Phone/Fax

Practice location:
  • Phone: 219-663-2532
  • Fax: 219-662-0714
Mailing address:
  • Phone: 260-724-2145
  • Fax: 260-728-3852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number060003601
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number060003601
License Number StateIN

VIII. Authorized Official

Name: MR. DANE WHEELER
Title or Position: CFO
Credential: CPA
Phone: 260-724-2145