| NPI | 1255844957 |
|---|---|
| Other Name | 10633 WEST J AVENUE |
| Entity Type | Organization |
| Authorized Contact | BARRY J. BRUNS President 269-660-0854 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: MI AS390252741) |
| Additional Taxonomies | 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| Enumeration Date | 2017-11-16 |
| Last Update Date | 2017-11-16 |