| NPI | 1598279283 |
|---|---|
| Other Name | 7519 S. 10TH STREET AFC |
| Entity Type | Organization |
| Authorized Contact | BARRY J. BRUNS President 269-660-0854 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: MI AS390324815) |
| Additional Taxonomies | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2017-11-17 |
| Last Update Date | 2017-11-17 |