| Southlake Community Mental Health Center, Inc | |
|
3903 Indianapolis Blvd East Chicago IN 46312-2555 | |
| (219) 398-7050 | |
| (219) 392-6998 |
| Full Name | Southlake Community Mental Health Center, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3903 Indianapolis Blvd, East Chicago, Indiana |
| Authorized Official Name and Position | Robert Krumwied (CEO) |
| Authorized Official Contact | 2197367183 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southlake Community Mental Health Center, Inc 8400 Louisiana St Merrillville IN 46410-6385 Ph: (219) 757-1924 | Southlake Community Mental Health Center, Inc 3903 Indianapolis Blvd East Chicago IN 46312-2555 Ph: (219) 398-7050 |
| NPI Number | 1376919217 |
|---|---|
| Provider Enumeration Date | 08/14/2015 |
| Last Update Date | 07/01/2016 |
| Medicare PECOS PAC ID | 5991600355 |
|---|---|
| Medicare Enrollment ID | O20150921001324 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376919217 | NPI | - | NPPES |
| 201323280A | Medicaid | IN | |
| 15D2100511 | Other | IN | CLIA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
219 Health Network, Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 4320 Fir St Unit 216, East Chicago, IN 46312 Phone: 219-392-7025 | |
Chikare Health Services Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 915 W Chicago Ave, East Chicago, IN 46312 Phone: 219-397-6000 Fax: 219-397-6358 | |
219 Health Network Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1802 E Columbus Dr, East Chicago, IN 46312 Phone: 219-397-6916 Fax: 219-397-9313 | |
Healthlinc, Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2106 Broadway St, East Chicago, IN 46312 Phone: 219-413-5118 Fax: 219-200-5020 | |
Nwi Home Doctor Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3847 Euclid Ave, East Chicago, IN 46312 Phone: 219-949-7540 | |
219 Health Network Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 100 W Chicago Ave Ste F, East Chicago, IN 46312 Phone: 219-392-7016 | |
Elgin Surgicare Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 521 W Chicago Ave, East Chicago, IN 46312 Phone: 630-345-0834 |