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Organization

NORTHSHORE HEALTH CENTERS, INC.

Active
Other names
NorthShore LaPorte Health Center
Organization subpart
No

Provider details

NPI number
Authorized official
DAVID HALL (CEO)
(219) 763-8112
Entity
Organization

Contact information

Practice address
508 LEGACY PLZ W, LA PORTE, IN 46350-5254
(219) 728-1638
(219) 728-1639
Mailing address
PO BOX 1430, PORTAGE, IN 46368-9230
(219) 763-8112
(219) 764-5380

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
103TC0700X
Clinical Psychologist
207Q00000X
Family Medicine Physician
2084P0800X
Psychiatry Physician
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
363LF0000X
Family Nurse Practitioner

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
151054
MEDICARE PTAN
IN
01
191360
MEDICARE
IN
05
300031202
IN
Enumeration date
07/03/2019
Last updated
06/19/2023
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