| NPI | 1538241211 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BARBARA ROSEBERRY Provider 313-282-9083 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: MI AS820014394) |
| Additional Taxonomies | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: MI AM820010034) |
| 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: MI AS820014636) | |
| 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: MI AS820094840) | |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2020-08-22 |