Healthcare Provider Details

I. General information

NPI: 1336059625
Provider Name (Legal Business Name): LA PORTE AL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/12/2026
Certification Date: 09/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3304 MONROE ST
LA PORTE IN
46350-6189
US

IV. Provider business mailing address

3304 MONROE ST
LA PORTE IN
46350-6189
US

V. Phone/Fax

Practice location:
  • Phone: 206-501-6732
  • Fax:
Mailing address:
  • Phone: 219-327-6195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: ALIDA C RAYNOR
Title or Position: CLINICAL COMPLIANCE NURSE
Credential: RN
Phone: 206-501-6732