Provider Demographics
NPI:1891262762
Name:COMMUNITY HEALTHNET INC
Entity Type:Organization
Organization Name:COMMUNITY HEALTHNET INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:SEABROOK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-880-1190
Mailing Address - Street 1:1021 W 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46402-1703
Mailing Address - Country:US
Mailing Address - Phone:219-880-1190
Mailing Address - Fax:219-979-2721
Practice Address - Street 1:3503 MARTIN LUTHER KING DRIVE
Practice Address - Street 2:COMMUNITY HEALTHNET INC - EAST
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46409-1233
Practice Address - Country:US
Practice Address - Phone:219-880-1190
Practice Address - Fax:219-880-0784
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY HEALTHNET INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200197530Medicaid