Provider Demographics
NPI:1821092347
Name:ADAMS COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:ADAMS COUNTY MEMORIAL HOSPITAL
Other - Org Name:SAINT ANNE HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:DANE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:260-724-2145
Mailing Address - Street 1:PO BOX 151
Mailing Address - Street 2:1100 MERCER AVENUE
Mailing Address - City:DECATUR
Mailing Address - State:IN
Mailing Address - Zip Code:46733
Mailing Address - Country:US
Mailing Address - Phone:260-724-2145
Mailing Address - Fax:260-728-3852
Practice Address - Street 1:1900 RANDALLIA DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-4632
Practice Address - Country:US
Practice Address - Phone:260-399-3256
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADAMS COUNTY MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-13
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05-000240-1314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100274960BMedicaid
IN100274960BMedicaid
IN4238220001Medicare NSC