| NPI | 1023314036 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WAYNE MICHAEL ISAILOVICH Executive Directror 219-756-3791 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: IN 1198-0-ASO) |
| Enumeration Date | 2011-02-09 |
| Last Update Date | 2011-02-09 |