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) 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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