NPIMap

Organization Active NPI

Edgewater Systems for Balanced Living, Inc

Doing business as New Life Center - Edgewater for Balanced Living

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Gary, IN
National Provider Identifier
1932732955
Registry record updated Feb 18, 2020
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
EDGEWATER SYSTEMS FOR BALANCED LIVING, INC
Doing business as
New Life Center - Edgewater for Balanced Living
Practice address
1110 W 5TH Ave
Gary, IN 46402-1723
Phone
(219) 885-4264
NPI assigned
Feb 18, 2020
Last updated
Feb 18, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2020

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) 885-4264

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU Primary
Methadone Clinic 261QM2800X NU

Addresses

Primary practice location

1110 W 5TH Ave
Gary, IN 46402-1723

Mailing address

1110 W 5TH Ave
Gary, IN 46402-1723
Phone (219) 885-4264

Other names 1

  • NEW LIFE CENTER - EDGEWATER FOR BALANCED LIVING Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Opioid treatment program
Medicare-enrolled since Feb 23, 2020

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200413000275 IN Part B Supplier - Opioid Treatment Program (Otp) 9234398397 Practice locations: Gary, IN

Other NPIs with the same Medicare PAC ID 8

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

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.

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Edgewater SystemsGary, IN, CCN 151057 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Oct 7, 1974

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 1

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": "1581984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581984000000",
    "number": "1932732955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1110 W 5TH AVE",
            "city": "GARY",
            "state": "IN",
            "postal_code": "464021723",
            "telephone_number": "219-885-4264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 W 5TH AVE",
            "city": "GARY",
            "state": "IN",
            "postal_code": "464021723",
            "telephone_number": "219-885-4264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDGEWATER SYSTEMS FOR BALANCED LIVING, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-18",
        "last_updated": "2020-02-18",
        "certification_date": "2020-02-18",
        "status": "A",
        "authorized_official_last_name": "HUGHES",
        "authorized_official_first_name": "DANITA",
        "authorized_official_middle_name": "JOHNSON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "219-885-4264"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NEW LIFE CENTER - EDGEWATER FOR BALANCED LIVING",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gary, IN

Sources for this page

Verify at the official NPI Registry.