| NPI | 1881128627 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURA ANNE BLOOM Owner 313-590-4740 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MI 6801092345) |
| Enumeration Date | 2017-04-19 |
| Last Update Date | 2017-04-19 |