| NPI | 1447383500 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN MCCLEES Executive Director 269-344-4458 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty (Licence: MI 390114) |
| Additional Taxonomies | 261QM2800X Clinic/Center, Methadone Clinic (Licence: MI 390114) |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2015-07-15 |