| NPI | 1356931513 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICARDO DAVID TILLERY CEO 517-703-3387 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 261QC1500X Clinic/Center, Community Health | |
| 3245S0500X Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children | |
| Enumeration Date | 2021-01-21 |
| Last Update Date | 2021-01-21 |