| NPI | 1336992999 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RHONA GILLIAM Contracting Specialist 219-763-8112 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2024-04-11 |
| Last Update Date | 2024-04-11 |