Organization
NORTHWEST INDIANA TREATMENT CENTER, LLC
Active
Other names
MedMark Treatment Centers Merrillville
Organization subpart
No
Provider details
NPI number
Authorized official
BRUCE JARVIE (VP, TREASURER)
(214) 379-3300
Entity
Organization
Contact information
Practice address
8500 BROADWAY, SUITE H, MERRILLVILLE, IN 46410-7006
(219) 769-7710
(219) 769-7758
Mailing address
1720 LAKEPOINTE DRIVE, SUITE 117, LEWISVILLE, TX 75057-6425
(214) 379-3000
(214) 853-9018
Taxonomy
Speciality
Code
Description
License number
State
261QM2800X
Methadone Clinic
Primary
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1177-2-OTF
SUBSTANCE ABUSE
IN
Enumeration date
04/07/2015
Last updated
07/29/2024
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