| NPI | 1861679664 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID R. HENDRICKS Physician 231-942-6670 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MI 4301038246) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: MI 6801035572) |
| Enumeration Date | 2008-01-24 |
| Last Update Date | 2018-05-14 |