Organization
CORVILLA INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JULIE A LUCKY MPA (EXECUTIVE DIRECTOR)
(574) 289-9779
Entity
Organization
Contact information
Practice address
18443 BULLA RD, SOUTH BEND, IN 46637-5426
(574) 277-8129
Mailing address
3231 SUGAR MAPLE BUSINESS CT, SOUTH BEND, IN 46628-4372
(574) 289-9779
(574) 289-0185
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
IN
Other
Enumeration date
04/03/2007
Last updated
08/22/2020
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