Healthcare Provider Details

I. General information

NPI: 1699630111
Provider Name (Legal Business Name): 219 HEALTH NETWORK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4320 FIR ST #410
EAST CHICAGO IN
46312-3050
US

IV. Provider business mailing address

100 W CHICAGO AVE STE F
EAST CHICAGO IN
46312-3261
US

V. Phone/Fax

Practice location:
  • Phone: 219-836-2995
  • Fax:
Mailing address:
  • Phone: 219-703-7016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM CORTES
Title or Position: ADMINISTRATOR
Credential:
Phone: 219-703-2585