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 |