| NPI | 1790994796 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLEE R. DERICO Administrator 317-632-1851 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3104A0625X Assisted Living Facility, Assisted Living, Mental Illness (Licence: IN 200523410) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2020-08-22 |