NPIMap

Organization Active NPI

Southlake Community Mental Health Center Inc.

  • Substance Use Disorder Rehabilitation Clinic/Center
  • East Chicago, IN
National Provider Identifier
1972092047
Registry record updated Jun 12, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
License
424-014 Issued in IN
Legal business name
SOUTHLAKE COMMUNITY MENTAL HEALTH CENTER INC.
Practice address
3903 Indianapolis Blvd
East Chicago, IN 46312
Phone
(219) 398-7050
Fax
(219) 392-3998
NPI assigned
May 4, 2018
Last updated
Jun 12, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2018

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
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X 424-014 IN Primary

Addresses

Primary practice location

3903 Indianapolis Blvd
East Chicago, IN 46312

Mailing address

8400 Louisiana St
Merrillville, IN 46410-6385
Phone (219) 757-1924

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 for Ment10 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.

Locations

559 State St
Hammond, IN 46320
Phone (219) 937-3300

8400 Louisiana St
Merrillville, IN 46410
Phone (219) 757-1924

Practitioners & affiliated clinicians

Practitioners 8

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": "1525392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1528761600000",
    "number": "1972092047",
    "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": "219-757-1924",
            "fax_number": "219-757-1950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3903 INDIANAPOLIS BLVD",
            "city": "EAST CHICAGO",
            "state": "IN",
            "postal_code": "46312",
            "telephone_number": "219-398-7050",
            "fax_number": "219-392-3998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHLAKE COMMUNITY MENTAL HEALTH CENTER INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-04",
        "last_updated": "2018-06-12",
        "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": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "IN",
            "license": "424-014",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in East Chicago, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2018; 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.