Individual
REELLA LEE BURRELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6345 ANGLING RD, PORTAGE, MI 49024-1703
(269) 312-8885
Mailing address
6345 ANGLING RD, PORTAGE, MI 49024-1703
(269) 348-4375
(269) 743-7134
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
AF390382592
MI
Other
Enumeration date
09/18/2017
Last updated
09/18/2017
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