Provider Demographics
NPI:1316188667
Name:COMMUNITY HOPSITAL OF LAGRANGE COUNTY,INC
Entity Type:Organization
Organization Name:COMMUNITY HOPSITAL OF LAGRANGE COUNTY,INC
Other - Org Name:SHIPSHEWANA FAMILY HEALTHCARE
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE VP--CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:NAFZIGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-373-7008
Mailing Address - Street 1:1900 CAREW STREET
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-4765
Mailing Address - Country:US
Mailing Address - Phone:260-373-9700
Mailing Address - Fax:260-373-9740
Practice Address - Street 1:8175 WEST US 20
Practice Address - Street 2:
Practice Address - City:SHIPSHEWANA
Practice Address - State:IN
Practice Address - Zip Code:46565-9169
Practice Address - Country:US
Practice Address - Phone:260-768-7432
Practice Address - Fax:260-768-7482
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY HOPSITAL OF LAGRANGE COUNTY,INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01061887A332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies