| NPI | 1790020535 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WENDY PREVOST Owner 906-228-3092 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MI 6801086422) |
| Enumeration Date | 2012-12-05 |
| Last Update Date | 2012-12-05 |