| NPI | 1104417872 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROLINE M RAY Authorized Agent 269-352-6713 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2021-01-26 |
| Last Update Date | 2021-01-26 |