| NPI | 1609507177 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERI MARISA KRAKOVICH Founder/CEO 317-373-1145 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 261QD1600X Clinic/Center, Developmental Disabilities |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| Enumeration Date | 2022-06-23 |
| Last Update Date | 2022-06-23 |