EDGEWATER HEALTH - MERRILLVILLE
NPI 1184303414
Clinic/Center - Federally Qualified Health Center (FQHC) in Merrillville, IN

Q: What is Edgewater Systems For Balanced Living, Inc's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Federally Qualified Health Center (FQHC), with taxonomy code 261QF0400X.

Active since July 13, 2023CLIA 15D2121920 · Waiver

5495 BROADWAY, MERRILLVILLE, IN 46410(219) 885-4264 Get Directions Write a Review

NPPES record last updated: July 26, 2023. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Jul 26, 2023, Jul 13, 2023 (2 updates tracked since 2023).

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About Edgewater Health - Merrillville NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

EDGEWATER HEALTH - MERRILLVILLE (NPI 1184303414) is a healthcare organization registered as a federally qualified health center (fqhc) in Merrillville, Indiana and active in the NPI registry since July 2023. The organization holds a CLIA Waiver certificate valid through November 15, 2026 and lists Danita Johnson Hughes, Ceo, as its authorized official.

NPPES Registry Identity

NPI1184303414

Entity TypeOrganization

Primary Taxonomy261QF0400X

Legal Business NameEDGEWATER SYSTEMS FOR BALANCED LIVING, INC

Location Address5495 BROADWAYMerrillville, IN 46410-1647

Mailing Address1100 W 6th AveGary, IN 46402-1711 · (219) 885-4264

Phone(219) 885-4264

Organization SubpartNo

Authorized OfficialDanita Johnson HughesCeo · (219) 885-4264

Enumeration DateJuly 13, 2023

Last NPPES UpdateJuly 26, 20232 updates tracked since enumeration

NPPES CertifiedJuly 26, 2023

✔ NPI 1184303414 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyClinic/Center · Federally Qualified Health Center (FQHC)Ambulatory Health Care Facilities

Taxonomy Code261QF0400X

Also ListedClinic/Center · Multi-SpecialtyTaxonomy 261QM1300X

5495 BROADWAY, Merrillville, IN 46410

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Other Names 1

Other NameEdgewater Health - Merrillville

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 15D2121920

Edgewater Health · Gary, IN

Active · expires Nov 15, 2026

CLIA Number15D2121920

Laboratory TypeFederally Qualified Health Center

Certificate Effective DateNovember 16, 2024

Certificate Expiration DateNovember 15, 2026

Laboratory DirectorGerri Browning

Laboratory Phone(219) 885-4264

Laboratory LocationEdgewater Health1100 West 6th Ave, Gary, IN 46402

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

CHAVONN L DEDEAUX FNP-C

Nurse Practitioner (Family)