| NPI | 1669674917 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CASSANDRA L DERRICK President, CEO, Licensee 248-640-4813 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: MI AS820281817) |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2020-08-22 |