| NPI | 1841467461 |
|---|---|
| Other Name | PROVIDENCE |
| Entity Type | Organization |
| Authorized Contact | JAMES C VAN DYKE CEO 317-338-4501 |
| Organization Subpart ? | No |
| Primary Taxonomy | 310500000X Intermediate Care Facility, Mental Illness (Licence: IN 2538P0011DE04) |
| Enumeration Date | 2008-05-13 |
| Last Update Date | 2014-01-08 |