Organization
SOUTHLAKE TRICITY RBA
Active
Other names
Lake Park Residential Care
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT D KRUMWIED MHA (CEO)
(219) 392-6010
Entity
Organization
Contact information
Practice address
2075 RIPLEY ST, LAKE STATION, IN 46405-1161
(219) 962-9437
Mailing address
2075 RIPLEY ST, LAKE STATION, IN 46405-1161
Taxonomy
Speciality
Code
Description
License number
State
311Z00000X
Custodial Care Facility
Primary
—
IN
Other
Enumeration date
03/16/2007
Last updated
08/22/2020
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