| Organization Name: | NUSOURCE EDUCATIONAL SERVICE |
| NPI Number: | 1124108733 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KATHERLYN THEDFORD (CHIEF OF OPERATIONS) |
| Mailing Address: | 4270 Ohio St Gary |
| State: | IN US |
| Postal Code: | 464092006 |
| Phone Number: | 2199806217 |
| Fax Number: | 2199858772 |
| NPI Enumeration Date: | 10/17/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM0801X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Mental Health (Including Community Mental Health Center) |
| Taxonomy Definition: | |