| NPI | 1598533853 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANGANO J KAGABO Program Manager 317-602-0991 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2023-12-18 |
| Last Update Date | 2023-12-18 |