Organization
MCMAHAN ADULT FOSTER CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY RENEE MCMAHAN (OWNER)
(810) 875-9681
Entity
Organization
Contact information
Practice address
1478 E BUDER AVE, BURTON, MI 48529-1606
(810) 875-9681
(810) 875-9681
Mailing address
1478 E BUDER AVE, BURTON, MI 48529-1606
(810) 875-9681
(810) 875-9681
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
AS250285536
MI
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
AS250285536
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
AS250285536
—
MI
Enumeration date
10/09/2008
Last updated
10/09/2008
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