Provider Demographics
NPI:1811562374
Name:219 HEALTH NETWORK, INC.
Entity Type:Organization
Organization Name:219 HEALTH NETWORK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
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:219-392-7016
Mailing Address - Fax:219-397-6904
Practice Address - Street 1:4320 FIR ST UNIT 408
Practice Address - Street 2:
Practice Address - City:EAST CHICAGO
Practice Address - State:IN
Practice Address - Zip Code:46312-3078
Practice Address - Country:US
Practice Address - Phone:219-554-4081
Practice Address - Fax:219-554-4088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-26
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty