Organization
EDEN PRAIRIE RESIDENTIAL CARE SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KEHINDE OLUGBOLAHAN OGUNDIPE (ADMINISTRATOR)
(214) 250-6576
Entity
Organization
Contact information
Practice address
302 WELCH BLVD, FLINT, MI 48503-1105
(214) 250-6576
(810) 337-1546
Mailing address
302 WELCH BLVD, FLINT, MI 48503-1105
(214) 250-6576
(810) 337-1546
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Enumeration date
10/09/2019
Last updated
10/09/2019
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