| NPI | 1639453871 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DWAYNE MITCHELL CEO 219-397-1196 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2011-10-06 |
| Last Update Date | 2011-10-06 |