Organization
SOUTHLAKE COMMUNITY MENTAL HEALTH CENTER, INC.
Active
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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