Organization
EDGEWATER SYSTEMS FOR BALANCED LIVING, INC
Active
Organization
EDGEWATER SYSTEMS FOR BALANCED LIVING, INC
Active
Other names
Edgewater Behavioral Health Services, Inc, EDGEWATER HEALTH RAPID ACCESS CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
DANITA JOHNSON-HUGHES (CEO)
(219) 881-2466
Entity
Organization
Contact information
Practice address
4747 W 24TH AVE, GARY, IN 46406
(219) 977-0110
(219) 427-1672
Mailing address
1100 W 6TH AVE, GARY, IN 46402-1711
(219) 885-4264
(219) 882-0352
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
421-009
IN
283Q00000X
Psychiatric Hospital
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300013628
—
IN
Enumeration date
04/30/2015
Last updated
06/16/2018
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