| NPI | 1104393206 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRY STAWAR CEO 812-206-1234 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| Enumeration Date | 2018-10-26 |
| Last Update Date | 2020-05-01 |