| NPI | 1891561262 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA MITCHELL CEO 219-465-9503 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 3336C0002X Pharmacy, Clinic Pharmacy |
| Additional Taxonomies | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2023-11-28 |
| Last Update Date | 2024-02-12 |