| NPI | 1528104643 |
|---|---|
| Other Name | GRAND RAPIDS |
| Entity Type | Organization |
| Authorized Contact | GEORGE JOHN TYNDALL Branch Director 616-224-7617 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: MI 410218) |
| Additional Taxonomies | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children (Licence: MI 635720364) |
| 251B00000X Case Management (Licence: MI CB410200976) | |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2013-10-24 |