| NPI | 1407848633 |
|---|---|
| Other Name | CDPH |
| Entity Type | Organization |
| Authorized Contact | SARAI M JACKSON Director Of Revenue 317-747-9443 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2020-08-22 |