| NPI | 1255189023 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICARDO TILLERY Authorized Agent 517-515-6176 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 261QC1500X Clinic/Center, Community Health | |
| 261QC1800X Clinic/Center, Corporate Health | |
| 261QP0905X Clinic/Center, Public Health, State or Local | |
| Enumeration Date | 2024-05-08 |
| Last Update Date | 2024-05-08 |