219 Health Network Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · East Chicago, IN
NPI 1366083776 · NPPES record last updated Aug 16, 2024
Key facts
- NPI
- 1366083776
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- 219 HEALTH NETWORK INC
- Practice address
- 2020 E Columbus Dr Ste a
East Chicago, IN 46312-2830 - Phone
- (219) 397-8965
- Fax
- (219) 397-9351
- NPI assigned
- Oct 7, 2019
- Organization subpart
- No
Authorized official
- Name
- William Cortes
- Title
- Executive Director
- Phone
- (219) 703-2585
Corporate family (same tax ID) 38
Practitioners 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
Federally qualified health center certification: CCN 151065
- Legal name
- 219 HEALTH NETWORK INC
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Oct 15, 2019
- Last certification
- Oct 15, 2019
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jul 27, 2017 in IN
- Enrollment address
- 2020 E Columbus Dr
Ste a
East Chicago, IN 46312-2830
All disclosed owners & managing parties 10
| Name | Role | Since | Share |
|---|---|---|---|
| Luis Molina |
Corporate Director |
May 1, 2018 | |
| William Cortes |
Corporate Officer |
Mar 31, 2024 | |
| W-2 Managing Employee |
Mar 31, 2024 | ||
| Gloria Vela |
Corporate Director |
May 1, 2018 | |
| Marjol Rush-Collet |
Corporate Director |
May 1, 2018 | |
| Leo Correa |
Corporate Director |
May 1, 2018 | |
| Sandra Noe |
Corporate Director |
May 1, 2018 | |
| Sava Pavkovich |
Corporate Director |
Oct 26, 2022 | |
| Milton Reed |
Corporate Director |
May 1, 2018 | |
| Sara Jiminez |
Corporate Director |
May 1, 2018 | |
| Martha Gonzalez |
Corporate Director |
Oct 26, 2022 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20191015000094 | IN | Part a Provider - Federally Qualified Health Center (FQHC) | 0547521452 | Practice locations: East Chicago, IN |
National Provider Directory
- Tax ID family
- 219 Health Network Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
2020 E Columbus Dr Ste a
East Chicago, IN 46312-2830
Mailing address
100 W Chicago Ave Ste F
East Chicago, IN 46312-3261
Phone (219) 703-2583
Other providers in East Chicago, IN
- 219 Health Network Inc
- 219 Health Network Inc
- 219 Health Network Inc
- 219 Health Network Inc
- 219 Health Network Inc
- 219 Health Network Inc
- 219 Health Network Inc
- 219 Health Network Inc
- 219 Health Network Inc
All providers in East Chicago, IN · Federally Qualified Health Center (FQHC) in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 16, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.