| NPI | 1679714539 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUDI B. BLEICH Clinical Social Worker 269-982-2955 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: MI 6801021227) |
| Enumeration Date | 2009-03-23 |
| Last Update Date | 2009-03-23 |