| NPI | 1790489920 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EUGENE GILLESPIE Licensee Designee 313-820-5548 |
| Organization Subpart ? | No |
| Primary Taxonomy | 253Z00000X In Home Supportive Care |
| Additional Taxonomies | 3104A0625X Assisted Living Facility, Assisted Living, Mental Illness |
| 320800000X Community Based Residential Treatment Facility, Mental Illness | |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| Enumeration Date | 2023-03-30 |
| Last Update Date | 2023-03-30 |