Organization
WALLOON LAKE RECOVERY LODGE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARTIN J GITRE (MEMBER)
(248) 763-0863
Entity
Organization
Contact information
Practice address
2594 SPRINGVALE RD, BOYNE FALLS, MI 49713
(231) 535-2415
Mailing address
2594 SPRINGVALE ROAD, BOYNE FALLS, MI 49713
(231) 535-2415
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
L183579
MI
Other
Enumeration date
11/17/2014
Last updated
11/17/2014
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