NPIMap

Organization Active NPI

Southlake Community Mental Health Center Inc.

Doing business as Regional Mental Health Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Merrillville, IN
National Provider Identifier
1902043672
Registry record updated May 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
SOUTHLAKE COMMUNITY MENTAL HEALTH CENTER INC.
Doing business as
Regional Mental Health Center
Practice address
8555 Taft St
Merrillville, IN 46410-6123
Phone
(219) 769-4005
NPI assigned
Jan 16, 2009
Last updated
May 24, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 24, 2022

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

Authorized official

Name
Shirley A Roll
Title
Enrollment
Phone
(317) 472-7396

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

8555 Taft St
Merrillville, IN 46410-6123

Mailing address

8400 Louisiana St
Merrillville, IN 46410-6385
Phone (219) 757-1928

Other identifiers 1

IdentifierTypeStateIssuer
100157670BMedicaidIN

Other names 1

  • Regional Mental Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20031201000049 IN Part B Supplier - Clinic/Group Practice 5991600355 Receives reassigned benefits from 38 practitioners
11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Hammond, IN; Merrillville, IN; Hobart, IN; East Chicago, IN; Highland, IN
O20031231000117 IN Part B Supplier - Clinic/Group Practice 5991600355 Receives reassigned benefits from 33 practitioners
11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: East Chicago, IN; Hammond, IN; Highland, IN; Hobart, IN; Merrillville, IN
O20040513000199 IN Part B Supplier - Clinic/Group Practice 5991600355 Receives reassigned benefits from 19 practitioners
11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Hobart, IN; Merrillville, IN; Highland, IN; Hammond, IN; East Chicago, IN

Other NPIs on the same Medicare enrollment 11

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Southlake Center Mental10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1232064000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1653350400000",
    "number": "1902043672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8400 LOUISIANA ST",
            "city": "MERRILLVILLE",
            "state": "IN",
            "postal_code": "464106385",
            "telephone_number": "219-757-1928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8555 TAFT ST",
            "city": "MERRILLVILLE",
            "state": "IN",
            "postal_code": "464106123",
            "telephone_number": "219-769-4005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHLAKE COMMUNITY MENTAL HEALTH CENTER INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-16",
        "last_updated": "2022-05-24",
        "certification_date": "2022-05-24",
        "status": "A",
        "authorized_official_last_name": "ROLL",
        "authorized_official_first_name": "SHIRLEY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "ENROLLMENT",
        "authorized_official_telephone_number": "317-472-7396"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100157670B",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Regional Mental Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Regional Mental Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Merrillville, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.