# BLACKBIRD CLINICAL SERVICES, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164669255
- **Authorized official:** MRS. KIMI L. HATHAWAY (PRESIDENT/ CEO)
- **Authorized official phone:** (765) 447-8700

## Contact information

- **Practice address:** 2 EXECUTIVE DR STE D, LAFAYETTE, IN 47905-4878
- **Practice address phone:** (765) 447-8700
- **Mailing address:** 2 EXECUTIVE DR STE D, LAFAYETTE, IN 47905-4878
- **Mailing address phone:** (765) 447-8700

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251K00000X | Public Health or Welfare Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 01/12/2009
- **Last updated:** 01/12/2009