Organization
BWL CARE, LLC
Active
Other names
Balanced Wholistic Living
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MIA LOVE NURSE PRACTITIONER (EXECUTIVE DIRECTOR)
(313) 922-7788
Entity
Organization
Contact information
Practice address
16861 WYOMING ST, DETROIT, MI 48221-2850
(313) 922-7788
Mailing address
19265 CANTERBURY RD, DETROIT, MI 48221-1859
(313) 922-7788
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1000594287
—
MI
Enumeration date
07/17/2018
Last updated
07/17/2018
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