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General NPI Number Information
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NPI Number | 1093005126
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Entity Type | Organization
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Legal Business Name | LAPORTE COUNTY HEALTH DEPARTMENT
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Dates
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Enumeration Date | 04/11/2011
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Last Update Date | 04/11/2011
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Provider Practice Location Address
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Address Line | 809 STATE ST SUITE 401A
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City | LA PORTE
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State | IN
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Zip | 46350-3385
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Country | US
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Telephone | 219-326-6808
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Fax | 219-325-8628
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Provider Business Mailing Address
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Address Line | 809 STATE STREET SUITE 401A
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City | LAPORTE
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State | IN
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Zip | 46350-3385
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Country | US
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Telephone | 219-326-6808
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Fax | 219-325-8628
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. TONY MANCUSO
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Credential |
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Telephone | 219-326-6808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number | 251K00000X
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License Number State | IN
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