| NPI | 1144672676 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICIA LYNN MAZYCK-SIMMONS Social Worker 734-787-8536 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2016-07-08 |
| Last Update Date | 2016-12-07 |