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Organization

GRANT-BLACKFORD MENTAL HEALTH, INC.

Active
Other names
RADIANT HEALTH SERVICES
Organization subpart
No

Provider details

NPI number
Authorized official
LISA A. DOMINISSE (CEO)
(765) 668-6713
Entity
Organization

Contact information

Practice address
505 N WABASH AVE, MARION, IN 46952-2608
(765) 662-3971
(765) 662-7480
Mailing address
505 N WABASH AVE, MARION, IN 46952-2608
(765) 662-3971
(765) 662-7480

Taxonomy

Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
414
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100123170A
IN
Enumeration date
08/16/2005
Last updated
09/08/2023
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