Healthcare Provider Details

I. General information

NPI: 1871689539
Provider Name (Legal Business Name): FRANCISCAN HEALTH LAFAYETTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 HARTFORD ST
LAFAYETTE IN
47904-2134
US

IV. Provider business mailing address

1501 HARTFORD ST
LAFAYETTE IN
47904-2134
US

V. Phone/Fax

Practice location:
  • Phone: 765-423-6780
  • Fax:
Mailing address:
  • Phone: 765-423-6780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number060050961
License Number StateIN

VIII. Authorized Official

Name: MR. TERRANCE E WILSON
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 765-502-4440