| NPI | 1174005714 |
|---|---|
| Doing Business As | ELAINE AVENUE |
| Entity Type | Organization |
| Authorized Contact | RHASHEDA SHEPHERD Contract And Compliance Manager 269-250-8228 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: MI CI390395642) |
| Enumeration Date | 2018-08-30 |
| Last Update Date | 2018-08-30 |