| NPI | 1245907344 |
|---|---|
| Doing Business As | EDGEWATER HEALTH: LAKE STREET PEDIATRICS |
| Entity Type | Organization |
| Authorized Contact | DANITA JOHNSON HUGHES CEO 219-885-4264 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2021-08-26 |
| Last Update Date | 2021-08-26 |