Organization
BLACKBIRD CLINICAL SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KIMI L. HATHAWAY (PRESIDENT/ CEO)
(765) 447-8700
Entity
Organization
Contact information
Practice address
2 EXECUTIVE DR STE D, LAFAYETTE, IN 47905-4878
(765) 447-8700
Mailing address
2 EXECUTIVE DR STE D, LAFAYETTE, IN 47905-4878
(765) 447-8700
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
—
—
Other
Enumeration date
01/12/2009
Last updated
01/12/2009
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