NPI | 1770097461 |
---|---|
Other Name | 6595 RAVINE ROAD AFC |
Entity Type | Organization |
Authorized Contact | BARRY J. BRUNS President 269-660-0854 |
Organization Subpart ? | Yes |
Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: MI AS390287535) |
Additional Taxonomies | 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
Enumeration Date | 2017-11-17 |
Last Update Date | 2017-11-17 |