| NPI | 1952061764 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIN M STARK Administrator 317-225-0489 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Additional Taxonomies | 3104A0630X Assisted Living Facility Assisted Living, Behavioral Disturbances |
| 310500000X Intermediate Care Facility, Mental Illness | |
| Enumeration Date | 2021-12-20 |
| Last Update Date | 2021-12-20 |