Organization
BANYAN SOBER LIVING OF MICHIGAN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MACKENZIE KOONCE (COO)
(231) 233-8474
Entity
Organization
Contact information
Practice address
1023 WASHTENAW RD, YPSILANTI, MI 48197-2161
(231) 233-8474
(734) 264-0732
Mailing address
PO BOX 272, MILFORD, MI 48381-0272
(231) 233-8474
(734) 264-0732
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Enumeration date
04/21/2014
Last updated
04/21/2014
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