| NPI | 1841791357 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE FENNEMA Managed Care Administrator 616-281-6372 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI SA0410417) |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility (Licence: MI SA0410417) |
| Enumeration Date | 2018-02-21 |
| Last Update Date | 2020-11-04 |