| NPI | 1639953136 |
|---|---|
| Doing Business As | THE CENTER FOR HEALTHY LIVING AT FORT WAYNE |
| Entity Type | Organization |
| Authorized Contact | TARA DENISE SCOTT Implementation Manager 423-602-9530 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261Q00000X |
| Enumeration Date | 2023-08-24 |
| Last Update Date | 2023-08-24 |