Provider Demographics
NPI:1477626026
Name:ADAMS COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:ADAMS COUNTY MEMORIAL HOSPITAL
Other - Org Name:LAKEVIEW MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SPRUNGER
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:260-724-2145
Mailing Address - Street 1:1100 MERCER AVENUE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IN
Mailing Address - Zip Code:46733-2303
Mailing Address - Country:US
Mailing Address - Phone:260-724-2145
Mailing Address - Fax:317-818-1022
Practice Address - Street 1:45 BEACHWAY DRIVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46224-8501
Practice Address - Country:US
Practice Address - Phone:317-243-3721
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11-000032-1314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100273330Medicaid
IN100273330Medicaid