Organization
COMMUNITY PROGRAMS AND SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD WAYNE BENNETT (PRESIDENT & CEO)
(734) 728-4201
Entity
Organization
Contact information
Practice address
32510 MICHIGAN AVE, WAYNE, MI 48184-1427
(734) 728-4201
(734) 728-4408
Mailing address
32510 MICHIGAN AVE, WAYNE, MI 48184-1427
(734) 728-4201
(734) 728-4408
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
MI
Other
Enumeration date
08/27/2007
Last updated
08/27/2007
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