Organization
ELMIRA INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LILLY PEARL HAYES (EXECUTIVE DIRECTOR)
(734) 459-6424
Entity
Organization
Contact information
Practice address
25855 CARLYSLE ST, INKSTER, MI 48141-2604
(734) 459-6424
(734) 459-6710
Mailing address
25855 CARLYSLE ST, INKSTER, MI 48141-2604
(734) 459-6424
(734) 459-6710
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
AS820014194
MI
Other
Enumeration date
12/03/2014
Last updated
12/03/2014
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