Organization
DON BOSCO HALL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES SMALL LMSW (EXECUTIVE DIECTION)
(313) 834-8677
Entity
Organization
Contact information
Practice address
10001 PETOSKEY AVE, DETROIT, MI 48204-3908
(313) 834-8677
Mailing address
10001 PETOSKEY AVE, DETROIT, MI 48204-3908
(313) 834-8677
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
C1820201096
MI
Other
Enumeration date
10/24/2008
Last updated
10/24/2008
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