| NPI | 1962958363 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL G HAGEDORN Member 812-499-7950 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: IN 87001568A) |
| Enumeration Date | 2016-08-26 |
| Last Update Date | 2016-11-06 |