| NPI | 1205229853 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMIE MARIE KUPRIS Supports Coordinator 616-248-5151 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: MI K162366585192) |
| Enumeration Date | 2015-03-06 |
| Last Update Date | 2015-03-06 |