Organization
EXCELSIOR HOME 1 INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KATHLEEN DAVIS (ADMINISTRATOR)
(313) 874-5404
Entity
Organization
Contact information
Practice address
129 VIRGINIA PARK, DETROIT, MI 48202
(313) 874-5594
(248) 208-0024
Mailing address
P.O.BOX 11387, DETROIT, MI 48202
(313) 874-5404
(248) 208-0024
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
MI
Other
Enumeration date
05/03/2007
Last updated
08/15/2007
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