Organization
EDGEWATER SYSTEMS FOR BALANCED LIVING, INC
Active
Organization
EDGEWATER SYSTEMS FOR BALANCED LIVING, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANITA JOHNSON-HUGHES (PRESIDENT AND CEO)
(219) 885-4264
Entity
Organization
Contact information
Practice address
1100 W 6TH AVE, GARY, IN 46402-1711
(219) 885-4264
(219) 882-0242
Mailing address
1100 W 6TH AVE, GARY, IN 46402-1711
(219) 885-4264
(219) 882-0242
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200079390
—
IN
Enumeration date
05/16/2007
Last updated
07/31/2019
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