| NPI | 1780055194 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHIRLEY HOLTON FALEER Owner 989-400-2367 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MI 6401006256) |
| Enumeration Date | 2015-10-12 |
| Last Update Date | 2015-10-12 |