Organization
SOUTHLAKE COMMUNITY MENTAL HEALTH CENTER, INC
Active
Other names
Regional Health Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT KRUMWIED (CEO)
(219) 736-7183
Entity
Organization
Contact information
Practice address
3903 INDIANAPOLIS BLVD, EAST CHICAGO, IN 46312-2555
(219) 398-7050
(219) 392-6998
Mailing address
8400 LOUISIANA ST, MERRILLVILLE, IN 46410-6385
(219) 757-1924
(219) 757-1950
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15D2100511
CLIA
IN
05
—
201323280A
—
IN
Enumeration date
08/14/2015
Last updated
07/01/2016
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