| NPI | 1174803571 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARCELLA MAREA PAYNE CHARLEY Owner 313-208-9947 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MI 6401009381) |
| Enumeration Date | 2011-08-17 |
| Last Update Date | 2011-08-17 |