Healthcare Provider Details

I. General information

NPI: 1942147574
Provider Name (Legal Business Name): CHILDREN WITH GREATER DESTINYS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 BIGGER ST
GARY IN
46404-2645
US

IV. Provider business mailing address

1901 BIGGER ST
GARY IN
46404-2645
US

V. Phone/Fax

Practice location:
  • Phone: 219-359-8128
  • Fax:
Mailing address:
  • Phone: 219-359-8128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: DESTINE GRAHAM
Title or Position: OWNER
Credential:
Phone: 219-359-8128