| Edgewater Systems for Balanced Living, Inc | |
|
900 Gerry St, Gary IN 46406 | |
| (844) 433-4392 | |
| (219) 888-9867 |
| Full Name | Edgewater Systems for Balanced Living, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 900 Gerry St,, Gary, Indiana |
| Authorized Official Name and Position | Danita Johnson-woods (CEO) |
| Authorized Official Contact | 2198854264 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Edgewater Systems for Balanced Living, Inc 1100 W 6th Ave Gary IN 46402-1711 | Edgewater Systems for Balanced Living, Inc 900 Gerry St, Gary IN 46406 Ph: (844) 433-4392 |
| NPI Number | 1093670648 |
|---|---|
| Provider Enumeration Date | 12/17/2025 |
| Last Update Date | 12/17/2025 |
| Certification Date | 12/17/2025 |
| Medicare PECOS PAC ID | 9234398397 |
|---|---|
| Medicare Enrollment ID | O20260310001659 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093670648 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | () | Primary |
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