| NPI | 1235203050 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY LYON Billing Coordinator 616-356-6285 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MI 6301009851) |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2020-08-22 |