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General NPI Number Information
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NPI Number | 1114257300
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Entity Type | Organization
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Legal Business Name | NORTHSHORE HEALTH CENTERS INC
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Dates
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Enumeration Date | 01/11/2010
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Last Update Date | 03/12/2013
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Provider Practice Location Address
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Address Line | 8555 TAFT ST
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City | MERRILLVILLE
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State | IN
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Zip | 46410-6123
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Country | US
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Telephone | 219-763-8112
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Fax | 219-764-3251
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Provider Business Mailing Address
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Address Line | PO BOX 1430
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City | PORTAGE
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State | IN
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Zip | 46368-9230
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Country | US
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Telephone | 219-763-8112
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Fax | 219-764-3251
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Authorized Official
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Title or Position | CEO
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Name | MRS. JANICE WILSON
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Credential |
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Telephone | 219-763-8112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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