| NPI | 1851642367 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDAL EUGENE DAME Certified Alcohol & Drug Counselo 231-728-2138 |
| Organization Subpart ? | No |
| Primary Taxonomy | 252Y00000X Early Intervention Provider Agency |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2012-09-24 |
| Last Update Date | 2012-09-24 |