Healthcare Provider Details

I. General information

NPI: 1679674956
Provider Name (Legal Business Name): COMMUNITY HOSPITAL OF LAGRANGE COUNTY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 N TOWNLINE RD
LAGRANGE IN
46761-1325
US

IV. Provider business mailing address

PO BOX 5600
FORT WAYNE IN
46895-5600
US

V. Phone/Fax

Practice location:
  • Phone: 260-463-2143
  • Fax: 260-463-3190
Mailing address:
  • Phone: 260-373-7008
  • Fax: 260-373-7059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number06-005085-1
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MRS. JESSICA LEE-HANSEN
Title or Position: CFO
Credential:
Phone: 312-388-0125