| NPI | 1700165834 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY WESLEY RAY Owner 313-449-6895 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251E00000X Home Health (Licence: MI AS820294980) |
| Additional Taxonomies | 310400000X Assisted Living Facility (Licence: MI AS820294980) |
| 3104A0625X Assisted Living Facility, Assisted Living, Mental Illness (Licence: MI AS820294980) | |
| 3104A0630X Assisted Living Facility, Assisted Living, Behavioral Disturbances (Licence: MI AS820294980) | |
| 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: MI AS820294980) | |
| Enumeration Date | 2011-08-07 |
| Last Update Date | 2011-08-07 |