| NPI | 1053963330 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IBRAHIM MOHAMMED NAJAMUDDIN Executive Director 219-703-2585 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2019-07-16 |
| Last Update Date | 2019-07-16 |