Doctor Name: | MARSHA CLARK |
NPI Number: | 1043689342 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | RN |
License Number: | 28139476A |
Business Practice Address: | 1100 W 6th Ave Gary, IN - 464021711 |
Business Phone Number: | 2192408615 |
Business Fax Number: | |
Mailing Address: | 1100 W 6th Ave, GARY |
State: | IN |
Postal Code: | 464021711 |
Phone Number: | 2192408615 |
Fax Number: | |
NPI Enumeration Date: | 09/17/2015 |
NPI Last Update Date: | 09/17/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 320900000X |
License Number: | 28139476A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Residential Treatment Facilities |
Taxonomy Classification: | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
Taxonomy Specialization: | |
Taxonomy Definition: | A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. |