| NPI | 1639394638 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRIS PROHL Executive Director 219-884-1138 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility Adult Care Home |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2020-08-22 |