| NPI | 1568997054 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACEY FOX Owner 269-355-0725 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MI 6801091193) |
| Enumeration Date | 2017-04-22 |
| Last Update Date | 2024-06-04 |