SOUTHLAKE COMMUNITY MENTAL HEALTH CENTER, INC (NPI# 1609231927) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1609231927 |
Entity Type | Organization |
Organization Name | SOUTHLAKE COMMUNITY MENTAL HEALTH CENTER, INC |
Other Organization Name | REGIONAL HEALTH CLINIC |
Practice Address |
4022 Hohman Ave Hammond IN 46327 |
Mailing Address |
8400 Louisiana St Merrillville IN 46410-6385 |
Practice Telephone | 2199373300 |
Practice Fax Number | 2198037252 |
Mailing Telephone | 2197571924 |
Mailing Fax Number | 2197571950 |
Enumeration Date | 2015-12-31 |
Last Update Date | 2016-07-01 |
Authorized Official Name | ROBERT KRUMWIED (CEO) |
Authorized Official Telephone | 2197367183 |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
State | Issuer | Identifier | Type Code |
---|---|---|---|
IN | CLIA | 15D2108285 | 01 |
IN | 201323280 | 05 |
Other Name | Type Code |
---|---|
Regional Health Clinic | Doing Business As Name - Organization |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1669973855 | Southlake Community Mental Health Center, Inc | Community/Behavioral Health | 107 W 79th Ave, Merrillville, IN 46410-5438 | 2018-02-23 |
1366942518 | Southlake Community Mental Health Center, Inc | Clinic/Center | 8555 Taft St, Merrillville, IN 46410-6123 | 2018-02-14 |
1376919217 | Southlake Community Mental Health Center, Inc | Clinic/Center | 3903 Indianapolis Blvd, East Chicago, IN 46312-2555 | 2015-08-14 |
Street Address |
4022 HOHMAN AVE |
City | HAMMOND |
State | IN |
Zip Code | 46327 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1437180346 | Rujuta R Gandhi | Family Medicine | 4022 Hohman Ave, Hammond, IN 46327-1239 | 2006-07-06 |
1942587449 | Lori Ann Morrow | Nurse Practitioner | 4022 Hohman Ave, Hammond, IN 46327-1239 | 2011-11-10 |
1306067392 | Sujittra Niyakorn | Family Medicine | 4022 Hohman Ave, Hammond, IN 46327-1239 | 2007-05-01 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1952445330 | William M. Bercik | Dentist | 3810 S Hohman Ave, Hammond, IN 46327-1159 | 2007-02-18 |
1295877694 | Hoosier Pharmacy | Pharmacy | 3833 Hohman Ave., Hammond, IN 46327-1160 | 2007-02-13 |
1558440149 | St Margaret Mercy Healthcare Centers | Family Medicine | 3831 S Hohman Ave, Hammond, IN 46327-1160 | 2006-11-03 |
1538151261 | Claude E Foreit | Family Medicine | 3831 Hohman Ave, Hammond, IN 46327-1160 | 2005-08-18 |
1508858069 | Claude A Foreit | Family Medicine | 3831 Hohman Ave, Hammond, IN 46327-1160 | 2005-08-19 |
1356333082 | Christopher John Mcintire | Family Medicine | 3831 Hohman Ave, Hammond, IN 46327-1160 | 2005-08-18 |
1659923894 | Genoa Healthcare, LLC | Pharmacy | 4022 Hohman Ave Ste 103, Hammond, IN 46327-1239 | 2019-07-09 |
1528285897 | St. Joseph Home for Boys, Inc | Residential Treatment Facility, Emotionally Disturbed Children | 4007 S Sheffield Ave, Hammond, IN 46327-1242 | 2007-04-19 |
1215545363 | Shenell Moore | Spec/Tech, Pathology | 225 Gostlin St, Hammond, IN 46327-1302 | 2020-07-15 |
1205346491 | Leo Jovan Corral | Specialist/Technologist | 4434 Cameron Ave, Hammond, IN 46327-1359 | 2017-10-03 |
Find all providers in zip 46327 |
Taxonomy Code | 261QF0400X |
Grouping | Ambulatory Health Care Facilities |
Classification | Clinic/Center |
Specialization | Federally Qualified Health Center (FQHC) |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1023642576 | Southlake Community Mental Health Center Inc. | Clinic/Center | 2250 173rd St Ste 111, Hammond, IN 46323-2074 | 2020-02-24 |
1376062513 | Southeast Community Health Systems | Clinic/Center | 43052 Yokum Rd, Hammond, LA 70403-6351 | 2017-09-19 |
1194277806 | Southeast Community Health Systems | Clinic/Center | 501 Erwin Neil Way Hammond, Hammond, LA 70403 | 2016-10-28 |
1568810794 | Southeast Community Health Systems | Clinic/Center | 1500 Phoenix Sq, Hammond, LA 70403-3954 | 2016-05-27 |
1841647013 | Southeast Community Health Systems | Clinic/Center | 125 W Tornado Dr, Hammond, LA 70401-1334 | 2016-05-18 |
1790163715 | Access Health Louisiana | Clinic/Center | 42351 Phyllis Ann Dr, Hammond, LA 70403-1254 | 2015-05-11 |
1508297540 | Southlake Community Mental Health Center, Inc. | Clinic/Center | 527 State St, Hammond, IN 46320-1533 | 2013-12-02 |
1881946267 | Community Healthnet, Inc | Clinic/Center | 5927 Columbia Ave, Hammond, IN 46320-2611 | 2012-10-09 |
1366617367 | Southeast Community Health Systems | Clinic/Center | 30575 Old Baton Rouge Highway, Hammond, LA 70403 | 2008-04-30 |
1265080295 | Access Health Louisiana | Clinic/Center | 2545 Veterans Ave, Hammond, LA 70403-1513 | 2019-09-03 |
Find all providers in HAMMOND |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.