Organization
EDGEWATER SYSTEMS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KENISHA RENEE PEDEN MSW (THERAPIST)
(219) 240-8615
Entity
Organization
Contact information
Practice address
4747 W 24TH AVE, GARY, IN 46406-2821
(219) 240-8615
(219) 977-1197
Mailing address
1100 W 6TH AVE, GARY, IN 46402-1711
(219) 240-8615
(219) 977-1197
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
09/16/2015
Last updated
09/16/2015
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