| Doctor Name: | HEATHER CARROLL |
| NPI Number: | 1346649688 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | COTA |
| License Number: | |
| Business Practice Address: | 430 E Cleveland Rd Granger, IN - 465305624 |
| Business Phone Number: | 5742713305 |
| Business Fax Number: | |
| Mailing Address: | 19839 Dice St, SOUTH BEND |
| State: | IN |
| Postal Code: | 466145513 |
| Phone Number: | 5742172213 |
| Fax Number: | |
| NPI Enumeration Date: | 08/21/2014 |
| NPI Last Update Date: | 08/21/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 3104A0625X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Nursing & Custodial Care Facilities |
| Taxonomy Classification: | Assisted Living Facility |
| Taxonomy Specialization: | Assisted Living, Mental Illness |
| Taxonomy Definition: | A facility providing supportive services to individuals who can function independently in most areas of activity, but need special guidance, assistance and/or monitoring as the result of a psychiatric problem. This type of facility requires a staff with special training in mental health training and dealing with psychiatric emergencies. |