NPI | 1053963330 |
---|---|
Entity Type | Organization |
Authorized Contact | IBRAHIM MOHAMMED NAJAMUDDIN 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 | 2024-08-16 |