Healthcare Provider Details

I. General information

NPI: 1912008772
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: 10/31/2024
Certification Date: 10/31/2024
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

VIII. Authorized Official

Name: MR. STANTON RISSER
Title or Position: ACFO
Credential:
Phone: 260-266-9380