| NPI | 1215105663 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JILL DIANE FORTE Board President 260-459-6040 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD1600X Clinic/Center, Developmental Disabilities |
| Enumeration Date | 2008-02-19 |
| Last Update Date | 2008-02-19 |