Organization
CORNERSTONE
Active
Parent organization
GRANT BLACKFORD MENTAL HELTH, INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
GRANT BLACKFORD MENTAL HELTH, INC
Authorized official
MR. PAUL KUCZORA (CEO)
(765) 662-3971
Entity
Organization
Contact information
Practice address
505 N WABASH AVE, MARION, IN 46952-2608
(765) 662-3971
Mailing address
505 N WABASH AVE, MARION, IN 46952-2608
(765) 662-3971
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
34006590A
IN
Other
Enumeration date
10/29/2012
Last updated
10/29/2012
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