=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457366189
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMMUNITY HOSPITAL OF NOBLE COUNTY, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/30/2006
-----------------------------------------------------
Last Update Date | 10/31/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 401 N SAWYER RD
-----------------------------------------------------
City | KENDALLVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46755
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 260-355-3304
-----------------------------------------------------
Fax | 260-347-8149
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 5600
-----------------------------------------------------
City | FORT WAYNE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46895-5600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 260-373-7008
-----------------------------------------------------
Fax | 260-373-7059
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ACFO
-----------------------------------------------------
Name | STANTON RISSER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 260-266-9380
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336I0012X
-----------------------------------------------------
Taxonomy Name | Institutional Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number | 06-002434-1
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------