| Edgewater Systems For Balanced Living, Inc | |
|
1110 W 5th Ave Gary IN 46402-1723 | |
| (219) 885-4264 | |
| Not Available |
| Full Name | Edgewater Systems For Balanced Living, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1110 W 5th Ave, Gary, Indiana |
| Authorized Official Name and Position | Danita Johnson Hughes (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 1110 W 5th Ave Gary IN 46402-1723 Ph: (219) 885-4264 | Edgewater Systems For Balanced Living, Inc 1110 W 5th Ave Gary IN 46402-1723 Ph: (219) 885-4264 |
| NPI Number | 1932732955 |
|---|---|
| Provider Enumeration Date | 02/18/2020 |
| Last Update Date | 02/18/2020 |
| Certification Date | 02/18/2020 |
| Medicare PECOS PAC ID | 9234398397 |
|---|---|
| Medicare Enrollment ID | O20200413000275 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932732955 | NPI | - | NPPES |
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