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General NPI Number Information
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NPI Number | 1356729586
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Entity Type | Organization
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Legal Business Name | NEW GARY COMMUNITY DEVELOPMENT CORP.
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Dates
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Enumeration Date | 05/07/2015
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Last Update Date | 05/07/2015
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Provider Practice Location Address
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Address Line | 4285 CLEVELAND ST
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City | GARY
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State | IN
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Zip | 46408-2429
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Country | US
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Telephone | 219-887-6418
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Fax | 219-887-2068
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Provider Business Mailing Address
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Address Line | 4285 CLEVELAND ST
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City | GARY
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State | IN
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Zip | 46408-2429
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Country | US
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Telephone | 219-887-6418
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Fax | 219-887-2068
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MRS. JOYCE FAYE OLIVER
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Credential | DR.
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Telephone | 219-887-6418
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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