Organization
CANNALUV
Active
Organization
CANNALUV
Active
Other names
Impaczo
Organization subpart
No
Provider details
NPI number
Authorized official
TAWANA BROWN (OWNER)
(702) 900-0532
Entity
Organization
Contact information
Practice address
2147 S ASTOR RD, BALDWIN, MI 49304-9354
(702) 900-0532
Mailing address
4741 MILLHAVEN DR SE, KENTWOOD, MI 49548-4386
(702) 900-0532
Taxonomy
Speciality
Code
Description
License number
State
253J00000X
Foster Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1235849654
—
NV
Enumeration date
09/26/2023
Last updated
09/26/2023
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