| NPI | 1861034225 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BETTY MACKIE Member 313-363-7018 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 261QA0600X Clinic/Center, Adult Day Care |
| Enumeration Date | 2019-10-16 |
| Last Update Date | 2022-01-31 |