IndividualActive
Jacquis Sistrunk
NPI 1447669098 · Mental Illness Community Based Residential Treatment Facility · Gary, IN
Provider details
- NPI number
- 1447669098
- Entity type
- Individual
- Primary specialty
- Mental Illness Community Based Residential Treatment FacilityResidential Treatment Facilities
- Sex
- Male
- Sole proprietor
- Yes
Specialties & taxonomies
Residential Treatment Facilities
Practice location
1100 W 6th Ave
Gary, IN 46402-1711
Phone: (219) 885-4264
Approximate (ZIP-level) locationGet directions
Mailing address
1100 W 6th Ave
Gary, IN 46402-1711
Registry dates
- Enumerated
- 2014-08-07
- Last updated
- 2014-08-07
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.