Provider Demographics
NPI:1720452014
Name:LAGRANGE COUNTY DBA LAGRANGE COUNTY HEALTH DEPARTMENT
Entity type:Organization
Organization Name:LAGRANGE COUNTY DBA LAGRANGE COUNTY HEALTH DEPARTMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HEALTH DEPARTMENT ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALFREDO
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:260-499-4182
Mailing Address - Street 1:304 N TOWNLINE RD
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:IN
Mailing Address - Zip Code:46761-1326
Mailing Address - Country:US
Mailing Address - Phone:260-499-4182
Mailing Address - Fax:260-499-4189
Practice Address - Street 1:304 N TOWNLINE RD
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:IN
Practice Address - Zip Code:46761-1326
Practice Address - Country:US
Practice Address - Phone:260-499-4182
Practice Address - Fax:260-499-4189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-24
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare