Provider Demographics
NPI:1568955037
Name:EDGEWATER SYSTEMS FOR BALANCED LIVING, INC
Entity Type:Organization
Organization Name:EDGEWATER SYSTEMS FOR BALANCED LIVING, INC
Other - Org Name:EDGEWATER HEALTH - TURNING POINT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-472-7396
Mailing Address - Street 1:1100 W 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46402-1711
Mailing Address - Country:US
Mailing Address - Phone:219-885-4264
Mailing Address - Fax:
Practice Address - Street 1:1110 W 5TH AVE
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46402-1723
Practice Address - Country:US
Practice Address - Phone:219-885-4264
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-11
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No283Q00000XHospitalsPsychiatric Hospital
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility