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) 769-4005
Entity
Organization
Contact information
Practice address
8555 TAFT ST, MERRILLVILLE, IN 46410-6123
(219) 937-3300
(219) 757-1950
Mailing address
8400 LOUISIANA ST, MERRILLVILLE, IN 46410-6385
(219) 757-1924
(219) 757-1928
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
Other
Enumeration date
08/10/2016
Last updated
08/15/2023
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