| NPI | 1215282678 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDRE PAUL GASTON Administrator 317-366-6082 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320700000X Residential Treatment Facility, Physical Disabilities |
| Enumeration Date | 2012-07-20 |
| Last Update Date | 2012-07-20 |