| NPI | 1154895993 |
|---|---|
| Doing Business As | CLUB SODA |
| Entity Type | Organization |
| Authorized Contact | KEVIN D BALL Program Director 812-230-4265 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2019-01-15 |
| Last Update Date | 2019-01-15 |