| NPI | 1619294634 |
|---|---|
| Doing Business As | EDA LEACH |
| Entity Type | Organization |
| Authorized Contact | EDA MONICA LEACH Social Worker 616-531-1142 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: MI 638107811) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 638107811) |
| 305S00000X Point of Service (Licence: MI 638107811) | |
| Enumeration Date | 2010-04-29 |
| Last Update Date | 2010-04-29 |