| NPI | 1982383196 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATISHA BLACKWELL Owner/Executive Director 313-138-2820 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3747A0650X Technician Attendant Care Provider |
| Additional Taxonomies | 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| Enumeration Date | 2023-07-14 |
| Last Update Date | 2023-07-14 |