| NPI | 1407234586 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAZMINE M FORD Owner 313-469-5946 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities (Licence: MI AS820367993) |
| Additional Taxonomies | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: MI AS820367993) |
| Enumeration Date | 2015-05-11 |
| Last Update Date | 2015-05-11 |