| NPI | 1952817389 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE MARIE CARTER Registered Dietetic Technician 313-492-8446 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP0904X Clinic/Center, Public Health, Federal |
| Additional Taxonomies | 251K00000X Public Health or Welfare |
| 251S00000X Community/Behavioral Health | |
| 251T00000X PACE Provider Organization | |
| 261QA0005X Clinic/Center, Ambulatory Family Planning Facility | |
| 261QC1500X Clinic/Center, Community Health | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QP0905X Clinic/Center, Public Health, State or Local | |
| 302R00000X Health Maintenance Organization | |
| Enumeration Date | 2017-12-21 |
| Last Update Date | 2017-12-21 |