| NPI | 1700288081 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURIE SCHEID RUDOLPH Owner 269-488-5903 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MI 6401009641) |
| Enumeration Date | 2014-09-18 |
| Last Update Date | 2016-06-29 |