| NPI | 1144855123 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN WICKSON Owner 810-964-0412 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2020-03-10 |
| Last Update Date | 2020-03-10 |