| NPI | 1194611665 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGEL BUMPHUS Administrator 317-993-2473 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| Enumeration Date | 2025-06-13 |
| Last Update Date | 2026-04-30 |