| NPI | 1013348051 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY SSN RATOWSKI Director Of Provider Affairs 248-703-2003 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD1600X Clinic/Center, Developmental Disabilities |
| Enumeration Date | 2013-12-02 |
| Last Update Date | 2024-03-15 |