EDGEWATER SYSTEMS FOR BALANCED LIVING INC. NPI 1588705784

NPI Information

NPI: 1588705784
Provider Name: EDGEWATER SYSTEMS FOR BALANCED LIVING, INC.
Classification: Clinic/Center - 261QM0801X
Entity Type: Organization

Specialization: Mental Health (Including Community Mental Health Center)

Address:
1100 W 6TH AVE
GARY, IN
ZIP 46402
Phone: (219) 885-4264
Get Directions

EDGEWATER SYSTEMS FOR BALANCED LIVING, INC. is a mental health (including community mental health center) clinic center in Gary, IN. EDGEWATER SYSTEMS FOR BALANCED LIVING, INC. NPI is 1588705784. The provider is registered as an organization entity type.

The provider's business location address is:

1100 W 6TH AVE
GARY, IN
ZIP 46402-711
Phone: (219) 885-4264
Fax: (219) 882-0242

The provider's authorized official is Lunette Lashaun Lott .
The authorized official title is Director Accts. Receivables and has the following contact phone number (219) 885-4264.

The enumeration date for this NPI number is 2/9/2007 and was last updated on 1/11/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QM0801X	Clinic/Center	Mental Health (Including Community Mental Health Center)			Yes
2	251S00000X	Community/Behavioral Health				No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	100273230	MEDICAID	INDIANA
2	200079390	MEDICAID	INDIANA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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