| NPI | 1104452812 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MIA WHITE Administrator 248-796-8033 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| 251E00000X Home Health | |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| 385H00000X Respite Care | |
| 385HR2055X Respite Care, Respite Care, Mental Illness, Child | |
| 385HR2060X Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child | |
| 385HR2065X Respite Care, Respite Care, Physical Disabilities, Child | |
| Enumeration Date | 2020-03-14 |
| Last Update Date | 2020-03-14 |