| NPI | 1184005589 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TABATHA CREASBAUM Owner 219-588-3540 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: IN 39002363A) |
| Enumeration Date | 2015-06-11 |
| Last Update Date | 2015-06-11 |