Organization
CHIKARE HEALTH SERVICES INC
Active
Other names
Immanuel Family Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
KANAYO K ODELUGA MD (OWNER/MD)
(219) 397-6000
Entity
Organization
Contact information
Practice address
915 W CHICAGO AVE, EAST CHICAGO, IN 46312
(219) 397-6000
(219) 397-6358
Mailing address
915 W CHICAGO AVE, EAST CHICAGO, IN 46312-3308
(219) 397-6000
(219) 397-6358
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15D0956269
CLIA
IN
05
—
200210560A
—
IN
01
—
CG2552
PALMETO GBA MEDICA
—
Enumeration date
12/22/2006
Last updated
06/18/2019
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