EDGEWATER SYSTERMS FOR BALANCED LIVING (NPI# 1790154417) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790154417 |
| Entity Type | Organization |
| Organization Name | EDGEWATER SYSTERMS FOR BALANCED LIVING |
| Practice Address |
1106 West 6 Th Avenue Gary IN 46402 |
| Practice Telephone | 2198854264 |
| Practice Fax Number | 2198851332 |
| Mailing Telephone | 2198854264 |
| Mailing Fax Number | 2198851332 |
| Enumeration Date | 2015-09-23 |
| Last Update Date | 2015-09-23 |
| Authorized Official Name | MR. THOMAS MICHAEL BUCKNER (THERAPIST II) |
| Authorized Official Telephone | 2198854264 |
| Authorized Official Credential | MA,NCC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251S00000X | Community/Behavioral Health | Agencies |
| Street Address |
1106 WEST 6 TH AVENUE |
| City | GARY |
| State | IN |
| Zip Code | 46402 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447642772 | Michael Pirtle | Counselor | 1100 W. Fifth Ave, Gary, IN 46402 | 2015-02-24 |
| 1356748370 | Peter F Uchman | Social Worker | 1100 W. 6th Ave., Gary, IN 46402 | 2014-11-20 |
| 1295142594 | Demetria A Macon | Counselor | 1100 W. 6th Ave, Gary, IN 46402 | 2014-07-18 |
| 1396952503 | 21st Century Charter School At Gary | Local Education Agency (LEA) | 556 W Washington, Gary, IN 46402 | 2007-05-17 |
| 1609094630 | Jomon Mathew | Physical Therapist | 353 Tyler St, Gary, IN 46402 | 2007-04-23 |
| 1376677138 | Kovilparambil Xavier Antony | Psychiatry & Neurology | 1100 W 6th Avenue, Gary, IN 46402 | 2007-03-15 |
| 1588759013 | Waltee Douglas | Psychologist | 667 Van Buren, Gary, IN 46402 | 2006-10-03 |
| 1851332514 | Thessa Grace Robertson | Emergency Medicine | 600 Grant Street, Gary, IN 46402 | 2006-06-10 |
| 1932672888 | The Methodist Hospitals, Inc | Pharmacy | 600 Grant St, Gary, IN 46402 | 2019-01-03 |
| 1497254296 | Callie Stephens | Licensed Practical Nurse | 1100 W 6th Ave, Gary, IN 46402 | 2018-02-07 |
| Find all providers in zip 46402 | ||||
| Taxonomy Code | 251S00000X |
| Grouping | Agencies |
| Classification | Community/Behavioral Health |
| A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. |
| Notes: Source: National Medicaid EDI HIPAA NPI Sub Work Group [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710599154 | We Are The Village Inc. | Community/Behavioral Health | 623 Washington St, Gary, IN 46402-2401 | 2020-08-18 |
| 1407291883 | Become Fabulous | Community/Behavioral Health | 1534 Garfield St, Gary, IN 46404-2725 | 2013-04-30 |
| 1184068264 | Timilla's Mentoring Center | Community/Behavioral Health | 1601 Broadway, Gary, IN 46407-2239 | 2013-04-19 |
| 1841634920 | Women In Unity | Community/Behavioral Health | 728 Georgia St, Gary, IN 46402-2613 | 2013-04-19 |
| 1659715753 | Women of Purpose & Destiny | Community/Behavioral Health | 5025 Madison St, Gary, IN 46408-4642 | 2013-04-19 |
| 1720422827 | Tip Toe Inn | Community/Behavioral Health | 839 Broadway # 104, Gary, IN 46402-2414 | 2013-04-19 |
| 1669799672 | Catholic Charities Diocese of Gary Inc | Community/Behavioral Health | 940 Broadway, Gary, IN 46402-2906 | 2010-04-29 |
| 1154504462 | Inner Connections Counseling & Consulting LLC | Community/Behavioral Health | 1976 Ohio St, Gary, IN 46407-2822 | 2007-12-10 |
| 1841412996 | Metro Treatment of Gary Lp | Community/Behavioral Health | 8000 Melton Rd., Gary, IN 46403-3114 | 2007-05-02 |
| 1184757320 | Middle Passage, Incorporated | Community/Behavioral Health | 4747 W 24th Ave, Gary, IN 46406-2821 | 2007-03-14 |
| Find all providers in GARY | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.