Provider Demographics
NPI:1659966398
Name:219 HEALTH NETWORK, INC.
Entity Type:Organization
Organization Name:219 HEALTH NETWORK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:LEO
Authorized Official - Middle Name:
Authorized Official - Last Name:CORREA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-392-7004
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:219-392-7016
Mailing Address - Fax:219-397-6904
Practice Address - Street 1:6625 W LINCOLN HWY STE 2
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-6611
Practice Address - Country:US
Practice Address - Phone:219-440-5353
Practice Address - Fax:219-440-5354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-04
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty