| NPI | 1285043406 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE RILEY Credentialing Specialist 313-221-8595 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) (Licence: MI 702008) |
| Additional Taxonomies | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2014-08-13 |
| Last Update Date | 2024-07-11 |