| NPI | 1679454177 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER L EVON Owner 313-439-0442 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0400X Clinic/Center, Rehabilitation |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2025-09-10 |
| Last Update Date | 2025-09-10 |