| NPI | 1861125932 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICIA JOHNSON Chief Executive Officer 219-703-2585 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism |
| Enumeration Date | 2022-07-06 |
| Last Update Date | 2022-07-06 |