Organization
THE MARY LANE CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMANIL JONES (EXECUTIVE DIRECTOR)
(219) 980-2440
Entity
Organization
Contact information
Practice address
4859 GEORGIA ST, GARY, IN 46409-2623
(219) 980-2440
(219) 980-3451
Mailing address
4859 GEORGIA ST, GARY, IN 46409-2623
(219) 980-2440
(219) 980-3451
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200913570A
—
IN
Enumeration date
11/10/2008
Last updated
11/10/2008
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