| NPI | 1306172747 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOAN DACOSTA Manger 313-882-3303 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320700000X Residential Treatment Facility, Physical Disabilities (Licence: MI 35304) |
| Additional Taxonomies | 347C00000X Private Vehicle (Licence: MI 35304) |
| 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: MI 35304) | |
| Enumeration Date | 2009-10-20 |
| Last Update Date | 2010-11-23 |