Provider Demographics
NPI:1952042368
Name:MERKAVA TREATMENT CENTER LLC
Entity Type:Organization
Organization Name:MERKAVA TREATMENT CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:574-240-4016
Mailing Address - Street 1:15719 CHILKAT TRL
Mailing Address - Street 2:
Mailing Address - City:HUNTERTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:46748-9220
Mailing Address - Country:US
Mailing Address - Phone:260-223-5611
Mailing Address - Fax:844-565-8144
Practice Address - Street 1:9010 CONNECTICUT ST
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-7057
Practice Address - Country:US
Practice Address - Phone:574-240-4016
Practice Address - Fax:844-565-8144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-07
Last Update Date:2023-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201248640Medicaid