| NPI | 1093005126 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TONY MANCUSO Administrator 219-326-6808 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251K00000X Public Health or Welfare (Licence: IN 251K00000X) |
| Enumeration Date | 2011-04-11 |
| Last Update Date | 2011-04-11 |