| NPI | 1962642595 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES SEEWALD Administrator 231-557-8308 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: MI AM610009197) |
| Enumeration Date | 2009-02-23 |
| Last Update Date | 2009-02-23 |