| NPI | 1700241528 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARRY EUGENE JIMISON Executive Director 317-931-0292 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2015-12-21 |
| Last Update Date | 2015-12-21 |