| NPI | 1043708357 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEVOUGHN T. OWENS Provider 248-240-7647 |
| Organization Subpart ? | No |
| Primary Taxonomy | 253J00000X Foster Care Agency (Licence: MI AS630247107) |
| Additional Taxonomies | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| 320700000X Residential Treatment Facility, Physical Disabilities | |
| 320800000X Community Based Residential Treatment Facility, Mental Illness | |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| Enumeration Date | 2018-04-23 |
| Last Update Date | 2018-04-23 |