| NPI | 1053054601 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAMILLE SCOTT TOLLIVER Executive Director 317-296-0338 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2022-04-20 |
| Last Update Date | 2022-04-20 |