Individual
DALENA S MOMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1022 ROYCE AVE, KALAMAZOO, MI 49001-4993
(269) 343-8480
(269) 343-5773
Mailing address
1022 ROYCE AVE, KALAMAZOO, MI 49001-4993
(269) 343-8480
(269) 343-5773
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
AF390069743
MI
Other
Enumeration date
07/12/2008
Last updated
07/12/2008
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