| NPI | 1598234056 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK CLARK President 231-780-0484 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| 324500000X Substance Abuse Rehabilitation Facility | |
| Enumeration Date | 2018-11-14 |
| Last Update Date | 2018-11-14 |