| NPI | 1316698749 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BENJAMIN P COVERT Billing 231-492-4207 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Additional Taxonomies | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children |
| Enumeration Date | 2022-01-18 |
| Last Update Date | 2022-04-07 |