NPIMap

Organization Active NPI

Edgewater Systems for Balanced Living, Inc

Doing business as Edgewater Health Rapid Access Center

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Gary, IN
National Provider Identifier
1770960536
Registry record updated Jun 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
License
421-009 Issued in IN
Legal business name
EDGEWATER SYSTEMS FOR BALANCED LIVING, INC
Doing business as
Edgewater Health Rapid Access Center
Edgewater Behavioral Health Services, Inc
Practice address
4747 W 24TH Ave
Gary, IN 46406
Phone
(219) 977-0110
Fax
(219) 427-1672
NPI assigned
Apr 30, 2015
Last updated
Jun 16, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Danita Johnson-Hughes
Title
Ceo
Phone
(219) 881-2466

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X 421-009 IN Primary
Psychiatric Hospital 283Q00000X NU
Substance Abuse Rehabilitation Facility 324500000X NU

Addresses

Primary practice location

4747 W 24TH Ave
Gary, IN 46406

Mailing address

1100 W 6TH Ave
Gary, IN 46402-1711
Phone (219) 885-4264

Other identifiers 1

IdentifierTypeStateIssuer
300013628MedicaidIN

Other names 2

  • EDGEWATER HEALTH RAPID ACCESS CENTER Doing business as
  • Edgewater Behavioral Health Services, Inc Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Edgewater System for Ba11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1430352000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1770960536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 W 6TH AVE",
            "city": "GARY",
            "state": "IN",
            "postal_code": "464021711",
            "telephone_number": "219-885-4264",
            "fax_number": "219-882-0352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4747 W 24TH AVE",
            "city": "GARY",
            "state": "IN",
            "postal_code": "46406",
            "telephone_number": "219-977-0110",
            "fax_number": "219-427-1672"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDGEWATER SYSTEMS FOR BALANCED LIVING, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-30",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "JOHNSON-HUGHES",
        "authorized_official_first_name": "DANITA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "219-881-2466"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "IN",
            "license": "421-009",
            "primary": true
        },
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300013628",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EDGEWATER HEALTH RAPID ACCESS CENTER",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Edgewater Behavioral Health Services, Inc",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Edgewater Behavioral Health Services, Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gary, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.