| NPI | 1023485356 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AILEEN WEHREN Vice President 219-476-4567 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2015-08-21 |
| Last Update Date | 2019-07-29 |