NPI 1083857320

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Organisation Mental Illness Community Based Residential Treatment Facility Clinton Township, MI

Practice location

Address: 24145 Grange St, Clinton Township, MI 48036-3008
Phone: (313) 743-2462

Authorised official

Name: Latasha Charlene Pemberton
Title: Provider
Phone: (313) 743-2462

Registered specialties

Mental Illness Community Based Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 320800000X

Other Community Based Residential Treatment Facility, Mental Illness providers in Michigan →

Registry record

NPI: 1083857320
Entity type: Organization
NPI issued: 16 Apr 2009
Record last updated: 16 Apr 2009

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.