| NPI | 1669667838 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AGNES CHONTOS Director 734-421-0959 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Additional Taxonomies | 311Z00000X Custodial Care Facility |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| Enumeration Date | 2007-09-11 |
| Last Update Date | 2007-09-11 |