Organization
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Organization subpart
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Provider details
NPI number
Authorized official
MS. LATASHA CHARLENE PEMBERTON (OWNER)
(313) 743-2462
Entity
Organization
Contact information
Practice address
24145 GRANGE ST, CLINTON TWP, MI 48036-3008
(313) 743-2462
Mailing address
24145 GRANGE ST, CLINTON TWP, MI 48036-3008
(313) 743-2462
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
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Other
Enumeration date
12/22/2009
Last updated
12/22/2009
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