| Edgewater Systems For Balanced Living, Inc | |
|
1100 W 6th Ave Gary IN 46402-1711 | |
| (219) 885-4264 | |
| (219) 882-0242 |
| Full Name | Edgewater Systems For Balanced Living, Inc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1100 W 6th Ave, Gary, Indiana |
| Authorized Official Name and Position | Danita Johnson-hughes (PRESIDENT AND CEO) |
| Authorized Official Contact | 2198854264 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Edgewater Systems For Balanced Living, Inc 1100 W 6th Ave Gary IN 46402-1711 Ph: (219) 885-4264 | Edgewater Systems For Balanced Living, Inc 1100 W 6th Ave Gary IN 46402-1711 Ph: (219) 885-4264 |
| NPI Number | 1225245822 |
|---|---|
| Provider Enumeration Date | 05/16/2007 |
| Last Update Date | 07/31/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225245822 | NPI | - | NPPES |
| 200079390 | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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