| NPI | 1396106258 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA M WAIDELICH Owner 517-488-5667 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MI 6401012853) |
| Enumeration Date | 2016-03-18 |
| Last Update Date | 2016-03-18 |