# NORTHSHORE HEALTH CENTERS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1497996839
- **Authorized official:** MRS. JANICE WILSON CEO (CEO)
- **Authorized official phone:** (219) 763-8112

## Contact information

- **Practice address:** 2490 CENTRAL AVE, LAKE STATION, IN 46405-2122
- **Practice address phone:** (219) 962-2760
- **Practice address fax:** (219) 962-1863
- **Mailing address:** PO BOX 1430, PORTAGE, IN 46368-9230
- **Mailing address phone:** (219) 763-8112
- **Mailing address fax:** (219) 764-5384

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | — | NULL | — |
| 1041C0700X | Clinical Social Worker | — | — | — |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | — |
| 208000000X | Pediatrics Physician | — | NULL | — |
| 208000000X | Pediatrics Physician | — | — | — |

## Other

- **Enumeration date:** 03/16/2009
- **Last updated:** 03/16/2009