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33300 Warren Rd Suite 17 Westland MI 48185-9627 | |
| (734) 331-0773 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 33300 Warren Rd, Westland, Michigan |
| Authorized Official Name and Position | Marilyn Kistler (OWNER / PROVIDER) |
| Authorized Official Contact | 7343310773 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
33300 Warren Rd Ste 13 Westland MI 48185-9627 Ph: (734) 331-0773 | 33300 Warren Rd Suite 17 Westland MI 48185-9627 Ph: (734) 331-0773 |
| NPI Number | 1063856599 |
|---|---|
| Provider Enumeration Date | 04/26/2013 |
| Last Update Date | 05/12/2023 |
| Certification Date | 05/12/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063856599 | NPI | - | NPPES |
| 1063856599 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 6401010853 (Michigan) | Primary |
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