| NPI | 1194811950 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MACK A. HALL Home Provider/President 313-247-8250 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: MI AS820080474) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2020-08-22 |