Healthcare Provider Details

I. General information

NPI: 1417955873
Provider Name (Legal Business Name): BOARD OF COMMISSIONERS OF NEWTON COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9951 N 100 E
LAKE VILLAGE IN
46349-9317
US

IV. Provider business mailing address

9951 N 100 E
LAKE VILLAGE IN
46349-9317
US

V. Phone/Fax

Practice location:
  • Phone: 888-663-9866
  • Fax: 219-345-2064
Mailing address:
  • Phone: 888-663-9866
  • Fax: 219-345-2064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number0251
License Number StateIN

VIII. Authorized Official

Name: JEREMY KALIZAE
Title or Position: DIRECTOR
Credential: EMT-P
Phone: 888-663-9866