| NPI | 1336674415 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALBERT EUGENE MACK Executive Director 877-267-3491 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: MI 6801011686) |
| Additional Taxonomies | 252Y00000X Early Intervention Provider Agency (Licence: MI 6801046708) |
| Enumeration Date | 2017-04-26 |
| Last Update Date | 2019-07-25 |