| NPI | 1508378134 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHARON HICKERSON Agent 317-531-7556 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2017-11-05 |
| Last Update Date | 2017-11-05 |