| NPI | 1316811474 |
|---|---|
| Former Legal Business Name | LEGACY OF ALL IS WELL 365, LLC |
| Entity Type | Organization |
| Authorized Contact | TREVA L GORDON Program Coordinator 313-418-2902 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251B00000X Case Management |
| Enumeration Date | 2025-10-01 |
| Last Update Date | 2025-12-16 |