| NPI | 1417997032 |
|---|---|
| Other Name | GROUP HOME |
| Entity Type | Organization |
| Authorized Contact | JAMES C. VAN DYKE CEO 317-338-4501 |
| Organization Subpart ? | No |
| Primary Taxonomy | 310500000X Intermediate Care Facility, Mental Illness (Licence: IN 2538T0009DE06) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2014-01-08 |