| Teens In Action, Inc. | |
|
1015 E 149th St East Chicago IN 46312-3771 | |
| (219) 397-5117 | |
| Not Available |
| Full Name | Teens In Action, Inc. |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1015 E 149th St, East Chicago, Indiana |
| Authorized Official Name and Position | Bridgette L Spann (DIRECTOR) |
| Authorized Official Contact | 2193975117 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Teens In Action, Inc. 1015 E 149th St East Chicago IN 46312-3771 Ph: (219) 397-5117 | Teens In Action, Inc. 1015 E 149th St East Chicago IN 46312-3771 Ph: (219) 397-5117 |
| NPI Number | 1982860813 |
|---|---|
| Provider Enumeration Date | 07/30/2008 |
| Last Update Date | 07/30/2008 |
| Medicare PECOS PAC ID | 3971669995 |
|---|---|
| Medicare Enrollment ID | O20190905002338 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982860813 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Bridgette Leora Spann Edwards |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174667745 PECOS PAC ID: 5193881530 Enrollment ID: I20190905002446 |
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