Provider Demographics
NPI:1154689750
Name:COMMUNITY HEALTHNET, INC
Entity Type:Organization
Organization Name:COMMUNITY HEALTHNET, INC
Other - Org Name:COMMUNITY HEALTHNET CONNECTICUT
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:SEABROOK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-484-2442
Mailing Address - Street 1:1021 W 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46402-1703
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8679 CONNECTICUT ST
Practice Address - Street 2:SUITE C
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6386
Practice Address - Country:US
Practice Address - Phone:219-880-1190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-02
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PENDINGMedicare Oscar/Certification