| NPI | 1942750740 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOY VICTORIA LANGEREIS Case Manager 616-780-6274 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: MI 6801100095) |
| Enumeration Date | 2016-10-05 |
| Last Update Date | 2016-10-05 |