Organization
SOUTHLAKE COMMUNITY MENTAL HEALTH CENTER INC.
Active
Other names
Regional Mental Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
SHIRLEY A ROLL (ENROLLMENT)
(317) 472-7396
Entity
Organization
Contact information
Practice address
8555 TAFT ST, MERRILLVILLE, IN 46410-6123
(219) 769-4005
Mailing address
8400 LOUISIANA ST, MERRILLVILLE, IN 46410-6385
(219) 757-1928
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100157670B
—
IN
Enumeration date
01/16/2009
Last updated
05/24/2022
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