Organization
SOUTHLAKE COMMUNITY MENTAL HEALTH CENTER INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHIRLEY A ROLL (ENROLLMENT)
(317) 472-7396
Entity
Organization
Contact information
Practice address
3903 INDIANAPOLIS BLVD, EAST CHICAGO, IN 46312
(219) 398-7050
(219) 392-3998
Mailing address
8400 LOUISIANA ST, MERRILLVILLE, IN 46410-6385
(219) 757-1924
(219) 757-1950
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
424-014
IN
Other
Enumeration date
05/04/2018
Last updated
06/12/2018
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