Organization
GRANT-BLACKFORD MENTAL HEALTH, INC.
Active
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
273R00000X
Psychiatric Hospital Unit
Primary
414-0-CMHC
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100273390
—
IN
Enumeration date
01/29/2007
Last updated
09/08/2023
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