Provider Demographics
NPI:1154381739
Name:EAST CHICAGO COMMUNITY HEALTH CENTER, INC.
Entity type:Organization
Organization Name:EAST CHICAGO COMMUNITY HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DWAYNE
Authorized Official - Middle Name:O
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:219-392-4900
Mailing Address - Street 1:P.O. BOX 59
Mailing Address - Street 2:
Mailing Address - City:EAST CHICAGO
Mailing Address - State:IN
Mailing Address - Zip Code:46312-0059
Mailing Address - Country:US
Mailing Address - Phone:219-397-1196
Mailing Address - Fax:219-392-4981
Practice Address - Street 1:1313 W. CHICAGO AVENUE
Practice Address - Street 2:
Practice Address - City:EAST CHICAGO
Practice Address - State:IN
Practice Address - Zip Code:46312-3316
Practice Address - Country:US
Practice Address - Phone:219-397-1196
Practice Address - Fax:219-392-4981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
151818Medicare Oscar/Certification
IN874570Medicare PIN