SOUTHLAKE TRICITY RBA
Custodial Care Facility
Lake Station, Indiana
Provider NPI: 1972637171
Organization Information:Organization Name: SOUTHLAKE TRICITY RBA
Practice Location:
2075 RIPLEY ST LAKE STATION, IN 46405 US
Tel: 219-962-9437 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
Practice Location:
2075 RIPLEY ST LAKE STATION, IN 46405 US
Tel: 219-962-9437 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
Primary | Code | Category/Description | State | License Number |
---|---|---|---|---|
Y | 311Z00000X | Nursing & Custodial Care Facilities Custodial Care Facility | IN |