| NPI | 1659966398 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEO CORREA Board Chairman 219-392-7004 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 208000000X Pediatrics |
| Enumeration Date | 2021-03-04 |
| Last Update Date | 2021-05-14 |