Organization
EDGEWATER HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PIERRE WOOD (THERAPIST)
(219) 885-4264
Entity
Organization
Contact information
Practice address
1100 W 6TH AVE, GARY, IN 46402-1711
(219) 885-4264
Mailing address
17 W 144TH ST APT 1W, RIVERDALE, IL 60827-2883
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
W300-6708-0246
DRIVER'S LICENSE
IL
Enumeration date
03/04/2019
Last updated
03/04/2019
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