Basic Information
| Provider Information | |||||||||
| NPI: | 1740527373 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FRANCISCAN HEALTH LAFAYETTE | ||||||||
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| OtherOrganizationName: | FAITH HOPE AND LOVE CANCER CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 781019 | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482781019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7655024000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1425 UNITY PL | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 479055756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7654477460 | ||||||||
| FaxNumber: | 7654478396 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2013 | ||||||||
| LastUpdateDate: | 09/16/2016 | ||||||||
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| AuthorizedOfficialLastName: | WILSON | ||||||||
| AuthorizedOfficialFirstName: | TERRANCE | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7655024000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | IN | N | Hospitals | General Acute Care Hospital | 2085R0001X | IN | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 261QX0203X | IN | Y | Ambulatory Health Care Facilities | Clinic/Center | Oncology, Radiation |
No ID Information.