Healthcare Provider Details

I. General information

NPI: 1558446393
Provider Name (Legal Business Name): INDIANA UNIVERSITY HEALTH LA PORTE HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 02/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 LINCOLNWAY
LA PORTE IN
46350-3201
US

IV. Provider business mailing address

1007 LINCOLNWAY
LA PORTE IN
46350-3201
US

V. Phone/Fax

Practice location:
  • Phone: 219-326-2494
  • Fax: 219-326-2387
Mailing address:
  • Phone: 219-326-2494
  • Fax: 219-326-2387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number06-005006-1
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number11-005006-1
License Number StateIN

VIII. Authorized Official

Name: MR. G THOR THORDARSON
Title or Position: CFO
Credential:
Phone: 219-326-2555