Provider Demographics
NPI:1508262916
Name:NEIGHBORHOOD HEALTH CLINICS, INC
Entity Type:Organization
Organization Name:NEIGHBORHOOD HEALTH CLINICS, INC
Other - Org Name:SOUTHEAST CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ZAEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-458-2646
Mailing Address - Street 1:1717 S CALHOUN ST
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46802-5257
Mailing Address - Country:US
Mailing Address - Phone:260-458-2641
Mailing Address - Fax:260-458-3093
Practice Address - Street 1:3350 E PAULDING RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46816-4513
Practice Address - Country:US
Practice Address - Phone:260-423-2585
Practice Address - Fax:260-422-9261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-12
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100050750BMedicaid