Healthcare Provider Details

I. General information

NPI: 1811923543
Provider Name (Legal Business Name): COMMUNITY HOSPITAL OF LAGRANGE COUNTY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 11/19/2019
Certification Date:
Deactivation Date: 04/24/2019
Reactivation Date: 11/19/2019

III. Provider practice location address

207 N TOWNLINE RD
LAGRANGE IN
46761-1325
US

IV. Provider business mailing address

207 N TOWNLINE RD
LAGRANGE IN
46761-1325
US

V. Phone/Fax

Practice location:
  • Phone: 260-463-9373
  • Fax: 260-463-9370
Mailing address:
  • Phone: 260-463-2143
  • Fax: 260-463-3790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number60005889A
License Number StateIN

VIII. Authorized Official

Name: BRENDA ARMENTROUT
Title or Position: PHARMACY MANAGER
Credential: PHARM D
Phone: 260-463-9373