| NPI | 1962828293 |
|---|---|
| Doing Business As | INDIAN LAKE COMMUNITY HEALTH CENTER |
| Entity Type | Organization |
| Authorized Contact | TARA D BAIR President/CEO 937-887-1013 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2014-03-11 |
| Last Update Date | 2016-12-12 |