| NPI | 1831979194 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID HALL CEO 219-763-8112 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2023-10-04 |
| Last Update Date | 2023-10-04 |