| NPI | 1255667366 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OSCAR SALERY Home Provider 313-702-7386 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: MI AS82094960) |
| Enumeration Date | 2009-10-23 |
| Last Update Date | 2009-10-23 |