Provider Demographics
NPI:1760257968
Name:NW INDIANA-AMG SPECIALTY HOSPITAL, INC.
Entity Type:Organization
Organization Name:NW INDIANA-AMG SPECIALTY HOSPITAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:LANE
Authorized Official - Last Name:MCGEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-269-9566
Mailing Address - Street 1:101 LA RUE FRANCE STE 500
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3144
Mailing Address - Country:US
Mailing Address - Phone:337-269-9566
Mailing Address - Fax:337-269-9823
Practice Address - Street 1:9509 GEORGIA ST
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-6518
Practice Address - Country:US
Practice Address - Phone:219-472-2200
Practice Address - Fax:219-472-2147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-17
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital