Organization
NORTHSHORE HEALTH CENTERS, INC.
Active
Organization
NORTHSHORE HEALTH CENTERS, INC.
Active
Other names
NorthShore St. John Community Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID HALL (CEO)
(219) 763-8112
Entity
Organization
Contact information
Practice address
9825 WICKER AVE SIDE, SAINT JOHN, IN 46373-9413
(219) 763-8112
(219) 764-5380
Mailing address
PO BOX 1430, PORTAGE, IN 46368-9230
(219) 763-8112
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
05/20/2021
Last updated
05/20/2021
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