Healthcare Provider Details

I. General information

NPI: 1366807802
Provider Name (Legal Business Name): LA PORTE HOSPITAL COMPANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2015
Last Update Date: 10/06/2017
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: 219-326-1234
  • Fax: 219-326-2387
Mailing address:
  • Phone: 219-326-1234
  • Fax: 219-326-2387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: PAULA M LALOR
Title or Position: DIRECTOR/DELEGATED OFFICIAL
Credential:
Phone: 615-925-4565