| NPI | 1700093143 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFERY JOSEPH LUSKO Clinical Program Manager 248-258-0440 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2021-04-15 |