| NPI | 1083237051 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICKIE HERNANDEZ Owner 616-403-9430 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2020-05-25 |
| Last Update Date | 2020-05-25 |