Provider Demographics
NPI:1639453871
Name:EAST CHICAGO COMMUNITY HEALTH CENTER
Entity Type:Organization
Organization Name:EAST CHICAGO COMMUNITY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DWAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-397-1196
Mailing Address - Street 1:PO BOX 59
Mailing Address - Street 2:1313 WEST CHICAGO AVE
Mailing Address - City:EAST CHICAGO
Mailing Address - State:IN
Mailing Address - Zip Code:46312-0000
Mailing Address - Country:US
Mailing Address - Phone:219-397-1196
Mailing Address - Fax:219-398-1630
Practice Address - Street 1:3903 INDIANAPOLIS BLVD
Practice Address - Street 2:EAST CHICAGO COMMUNITY HEALTH CENTER AT REGIONAL
Practice Address - City:EAST CHICAGO
Practice Address - State:IN
Practice Address - Zip Code:46312-0000
Practice Address - Country:US
Practice Address - Phone:219-397-1196
Practice Address - Fax:219-398-1630
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAST CHICAGO COMMUNITY HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)