Organization
NORTHSHORE HEALTH CENTERS, INC.
Active
Organization
NORTHSHORE HEALTH CENTERS, INC.
Active
Parent organization
NORTHSHORE HEALTH CENTERS, INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
NORTHSHORE HEALTH CENTERS, INC.
Authorized official
DAVID HALL (CEO)
(219) 763-8112
Entity
Organization
Contact information
Practice address
2490 CENTRAL AVE STE B, LAKE STATION, IN 46405-2122
(219) 962-5909
(219) 962-5981
Mailing address
PO BOX 1430, PORTAGE, IN 46368-9230
(219) 763-8112
(219) 764-5380
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
3336C0002X
Clinic Pharmacy
—
—
Other
Enumeration date
02/25/2009
Last updated
09/22/2020
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