Provider Demographics
NPI:1093005126
Name:LAPORTE COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:LAPORTE COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:MANCUSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-326-6808
Mailing Address - Street 1:809 STATE STREET
Mailing Address - Street 2:SUITE 401A
Mailing Address - City:LAPORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350-3385
Mailing Address - Country:US
Mailing Address - Phone:219-326-6808
Mailing Address - Fax:219-325-8628
Practice Address - Street 1:809 STATE ST
Practice Address - Street 2:SUITE 401A
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-3385
Practice Address - Country:US
Practice Address - Phone:219-326-6808
Practice Address - Fax:219-325-8628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN251K00000X251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare