| NPI | 1861684870 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CYNDI MUSTO Program Manager 616-356-6216 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MI 6801086216) |
| Enumeration Date | 2007-08-14 |
| Last Update Date | 2007-08-14 |