Organization
EDGEWATER SYSTEMS FOR BALANCED LIVING, INC.
Active
Parent organization
EDGEWATER SYSTEMS FOR BALANCED LIVING, INC.
Other names
Edgewater Primary Care
Organization subpart
Yes
Provider details
NPI number
Legal business name
EDGEWATER SYSTEMS FOR BALANCED LIVING, INC.
Authorized official
DR. DANITA JOHNSON HUGHES PHD. (PRESIDENT/CEO)
(219) 885-4264
Entity
Organization
Contact information
Practice address
5495 BROADWAY, MERRILLVILLE, IN 46410-1647
(219) 884-4900
(219) 980-7585
Mailing address
1100 W 6TH AVE, GARY, IN 46402-1711
(219) 885-4264
(219) 882-0962
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
—
—
207R00000X
Internal Medicine Physician
Primary
01033511A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200030490A
—
IN
Enumeration date
10/13/2016
Last updated
11/22/2024
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