| NPI | 1598007171 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JORDAN P BOUDREAU Owner 231-497-0555 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MI 1-09-5852) |
| Enumeration Date | 2013-03-21 |
| Last Update Date | 2013-03-21 |