Organization
SOUTHLAKE COMMUNITY MENTAL HEALTH CENTER INC.
Active
Other names
PNW CLINIC
Organization subpart
No
Provider details
NPI number
Authorized official
JUDITH SIKORA (CFO)
(219) 757-1921
Entity
Organization
Contact information
Practice address
2250 173RD ST STE 111, HAMMOND, IN 46323-2074
(219) 769-4005
Mailing address
8555 TAFT ST, MERRILLVILLE, IN 46410-6123
(219) 769-4005
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
02/24/2020
Last updated
02/26/2020
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