| NPI | 1053944058 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IBRAHIM MOHAMMED NAJAMUDDIN CEO 219-703-2585 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2020-02-18 |
| Last Update Date | 2020-02-18 |