| NPI | 1720842123 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VALISA D GLOVER Administrator 313-422-5711 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Enumeration Date | 2024-02-07 |
| Last Update Date | 2024-09-18 |