Organization
ADIA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BEATA MPESHA (LICENSEE)
(616) 856-0163
Entity
Organization
Contact information
Practice address
3981 WEDGEWOOD DR SW, WYOMING, MI 49519-3137
(616) 734-6194
Mailing address
3981 WEDGEWOOD DR SW, WYOMING, MI 49519-3137
(616) 734-6194
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
933217
—
MI
Enumeration date
01/18/2023
Last updated
01/18/2023
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