| NPI | 1972092047 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHIRLEY A ROLL Enrollment 317-472-7396 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: IN 424-014) |
| Enumeration Date | 2018-05-04 |
| Last Update Date | 2018-06-12 |