Provider Demographics
NPI:1790158244
Name:HEALTHLINC, INC
Entity Type:Organization
Organization Name:HEALTHLINC, INC
Other - Org Name:HEALTHLINC - SOUTH BEND (MEDICAL)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-465-9503
Mailing Address - Street 1:951 TRANSPORT DR
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-8434
Mailing Address - Country:US
Mailing Address - Phone:219-477-6082
Mailing Address - Fax:219-465-9502
Practice Address - Street 1:1960 NORTHSIDE BOULEVARD
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46615
Practice Address - Country:US
Practice Address - Phone:574-307-7673
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTHLINC, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-11-05
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)