| NPI | 1538484209 |
|---|---|
| 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 | 3336C0002X Pharmacy, Clinic Pharmacy |
| Enumeration Date | 2010-04-06 |
| Last Update Date | 2024-09-05 |