| NPI | 1538202056 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBECCA J RUSSELL Sole Member President 269-429-8770 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MI 6301010732) |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2008-06-16 |