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NPI Code Detail

MEDICARE: GRANT-BLACKFORD MENTAL HEALTH, INC.

MEDICARE: GRANT-BLACKFORD MENTAL HEALTH, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency414-0-CMHCIN

General Provider Information

NPI Number : 1689710741
Entity Type Code : Organization
Provider Name (Legal Business Name) : GRANT-BLACKFORD MENTAL HEALTH, INC.
Provider Business Mailing Address
First Line : 505 N WABASH AVE
Second Line :
City : MARION
State : IN
Zip : 46952-2608
Country : US
Telephone Number : 765-662-3971
Fax Number : 765-662-7480
Provider Business Practice Location Address
First Line : 118 E WASHINGTON ST
Second Line :
City : HARTFORD CITY
State : IN
Zip : 47348-2210
Country : US
Telephone Number : 765-384-1303
Fax Number : 765-662-7480
Authorized Official
Title or Position : CEO
Name : LISA A. DOMINISSE
Credential :
Telephone Number : 765-668-6713
Provider Enumeration Date : 01/29/2007
Last Update Date : 09/08/2023

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Directions to “GRANT-BLACKFORD MENTAL HEALTH, INC. ” Practice Location

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