MEDICARE: COMMUNITY HEALTHNET, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1790539963
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY HEALTHNET, INC

Provider Business Mailing Address
First Line	:	1021 W 5TH AVE
Second Line	:
City	:	GARY
State	:	IN
Zip	:	46402-1703
Country	:	US
Telephone Number	:	219-880-1190
Fax Number	:	219-880-0784

Provider Business Practice Location Address
First Line	:	1100 W COLUMBUS DR
Second Line	:
City	:	EAST CHICAGO
State	:	IN
Zip	:	46312-2582
Country	:	US
Telephone Number	:	219-880-1190
Fax Number	:	219-880-0784

Authorized Official
Title or Position	:	CEO
Name	:	DR. JANET SEABROOK
Credential	:	MD
Telephone Number	:	219-880-1190

Provider Enumeration Date	:	04/15/2024
Last Update Date	:	04/15/2024

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