Organization
REFUGE CLINIC, LLC
Active
Parent organization
NWI MDVIP LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
NWI MDVIP LLC
Authorized official
DR. BRENT JACOBUS DO (OWNER PHYSICIAN)
(219) 306-0752
Entity
Organization
Contact information
Practice address
9150 E 109TH AVE STE 2B, CROWN POINT, IN 46307-7686
(219) 213-2947
(219) 310-8175
Mailing address
9150 E 109TH AVE STE 2B, CROWN POINT, IN 46307-7686
(219) 213-2947
(219) 310-8175
Taxonomy
Speciality
Code
Description
License number
State
207QA0401X
Addiction Medicine (Family Medicine) Physician
Primary
—
—
Other
Enumeration date
08/25/2025
Last updated
08/25/2025
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