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FQHCLA392 Edgewater Systems For Balanced Living, Inc. (Active)
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Main Details
Name
Edgewater Systems For Balanced Living, Inc.
Subdivision Name
Primary Care - Griffith
Type
Health Center Program Look-Alike
Site ID
BPS-LAL-027807
340B ID
FQHCLA392
Grant Number
LALCS33108
Additional Details
Current Program Status
Active
Registration Date
7/3/2019
Participating Start Date
10/1/2019
Participating Approval Date
7/10/2019
Last Recertification Date
2/17/2025
Contacts
Authorizing Official
Edgewater Health
Danita A Johnson, CEO
(219) 806-3556
Primary Contact
Edgewater Health
Michael Andre LaBroi, Chief Information Officer
(219) 885-4264 Ext: 2624
Addresses
Street Address
1212 N Broad St
Griffith, IN 46319-1534
Billing Address
Edgewater Health
1100 W 6th Ave
Gary, IN 46402
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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