Organization
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Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. GAIL WILLIAMS MASTERS (VICE PRESIDENT)
(313) 962-8340
Entity
Organization
Contact information
Practice address
2727 SECOND AVE SUITE 124, DETROIT, MI 48201-4025
(313) 962-8340
Mailing address
2727 2ND AVE STE 124, DETROIT, MI 48201-2658
(313) 962-8340
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
320800000X
MI
Other
Enumeration date
09/27/2013
Last updated
10/24/2013
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