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General NPI Number Information
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NPI Number | 1679674956
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Entity Type | Organization
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Legal Business Name | COMMUNITY HOSPITAL OF LAGRANGE COUNTY INC
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 10/31/2024
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Provider Practice Location Address
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Address Line | 207 N TOWNLINE RD
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City | LAGRANGE
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State | IN
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Zip | 46761-1325
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Country | US
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Telephone | 260-463-2143
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Fax | 260-463-3190
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Provider Business Mailing Address
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Address Line | PO BOX 5600
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City | FORT WAYNE
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State | IN
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Zip | 46895-5600
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Country | US
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Telephone | 260-373-7008
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Fax | 260-373-7059
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Authorized Official
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Title or Position | INTERIM CFO - VP FINANCE
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Name | MR. STANTON RISSER
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Credential |
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Telephone | 260-266-9380
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336I0012X
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Taxonomy Name | Institutional Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 282NC0060X
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Taxonomy Name | Critical Access Hospital
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License Number | 06-005085-1
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License Number State | IN
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