Provider Demographics
NPI:1578025896
Name:219 HEALTH NETWORK INC
Entity Type:Organization
Organization Name:219 HEALTH NETWORK INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:IBRAHIM
Authorized Official - Middle Name:MOHAMMED
Authorized Official - Last Name:NAJAMUDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-703-2585
Mailing Address - Street 1:100 W CHICAGO AVE STE F
Mailing Address - Street 2:
Mailing Address - City:EAST CHICAGO
Mailing Address - State:IN
Mailing Address - Zip Code:46312-3261
Mailing Address - Country:US
Mailing Address - Phone:219-365-7620
Mailing Address - Fax:
Practice Address - Street 1:4320 FIRST STREET
Practice Address - Street 2:SUITE 211
Practice Address - City:EAST CHICAGO
Practice Address - State:IN
Practice Address - Zip Code:46312
Practice Address - Country:US
Practice Address - Phone:219-703-2577
Practice Address - Fax:219-703-6679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-04
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)