Organization
U1ST TRANSITIONAL LIVING PROGRAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TAMARIS HENAGAN JD (CEO)
(734) 506-6081
Entity
Organization
Contact information
Practice address
227 N WINTER ST, ADRIAN, MI 49221-2066
(734) 506-6081
Mailing address
227 N WINTER ST, ADRIAN, MI 49221-2066
(734) 474-1620
Taxonomy
Speciality
Code
Description
License number
State
405300000X
Prevention Professional
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
72026R
STATE INCORPORATION
MI
Enumeration date
08/28/2018
Last updated
08/28/2018
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