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1366816084
IEISHA MOFFETT
GARY, IN
NPI
1366816084
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
320800000X Community Based Residential Treatment Facility, Mental Illness
Enumeration Date
2015-11-18
Last Update Date
2015-11-18
Business Address
IEISHA MOFFETT
1100 W 6TH AVE
GARY, IN 46402-1711
Phone number: 219-885-4264
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Mailing Address
IEISHA MOFFETT
1100 W 6TH AVE
GARY, IN 46402-1711
Phone number: 219-885-4264
Copy
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