| NPI | 1497862098 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICIA EHLERT Claims Administrator 248-443-0105 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: IN 1400-0-ASR) |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: MI 630740) |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: OH 12497) | |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2020-08-22 |