| NPI | 1821267576 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID A TILLISON Director 317-728-1372 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2008-02-27 |
| Last Update Date | 2008-07-24 |