| NPI | 1356530505 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID HALL CEO 219-763-8112 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| 124Q00000X Dental Hygienist | |
| 2085B0100X Radiology, Body Imaging | |
| Enumeration Date | 2007-10-23 |
| Last Update Date | 2020-09-22 |