| NPI | 1306300165 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLIE COCHRAN Owner 313-442-6027 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251B00000X Case Management |
| Additional Taxonomies | 251S00000X |
| 252Y00000X Early Intervention Provider Agency | |
| 261QD1600X Clinic/Center, Developmental Disabilities | |
| 261QH0100X Clinic/Center, Health Services | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| 261QS1000X Clinic/Center, Student Health | |
| 322D00000X Residential Treatment Facility, Emotionally Disturbed Children | |
| Enumeration Date | 2019-01-25 |
| Last Update Date | 2019-10-05 |