| Graciela E. Hernandez Medical Corporation P C | |
|
4320 Fir Street East Chicago IN 46312-3076 | |
| (219) 397-2929 | |
| (219) 397-2929 |
| Full Name | Graciela E. Hernandez Medical Corporation P C |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 4320 Fir Street, East Chicago, Indiana |
| Authorized Official Name and Position | Graciela E Hernandez (PRESIDENT) |
| Authorized Official Contact | 2199372929 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Graciela E. Hernandez Medical Corporation P C 4320 Fir Street East Chicago IN 46312-3076 Ph: (219) 397-2929 | Graciela E. Hernandez Medical Corporation P C 4320 Fir Street East Chicago IN 46312-3076 Ph: (219) 397-2929 |
| NPI Number | 1417250606 |
|---|---|
| Provider Enumeration Date | 12/10/2010 |
| Last Update Date | 06/01/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417250606 | NPI | - | NPPES |
| 100213510A | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 011029949 (Indiana) | Primary |
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