Healthcare Provider Details

I. General information

NPI: 1821092347
Provider Name (Legal Business Name): ADAMS COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 03/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 RANDALLIA DR
FORT WAYNE IN
46805-4632
US

IV. Provider business mailing address

PO BOX 151 1100 MERCER AVENUE
DECATUR IN
46733
US

V. Phone/Fax

Practice location:
  • Phone: 260-399-3256
  • Fax:
Mailing address:
  • Phone: 260-724-2145
  • Fax: 260-728-3852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number05-000240-1
License Number StateIN

VIII. Authorized Official

Name: DANE WHEELER
Title or Position: CFO/TREASURER
Credential: CPA
Phone: 260-724-2145