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) 736-7183
Entity
Organization
Contact information
Practice address
4022 HOHMAN AVE, HAMMOND, IN 46327
(219) 937-3300
(219) 803-7252
Mailing address
8400 LOUISIANA ST, MERRILLVILLE, IN 46410-6385
(219) 757-1924
(219) 757-1950
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15D2108285
CLIA
IN
05
—
201323280
—
IN
Enumeration date
12/31/2015
Last updated
07/01/2016
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