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General NPI Number Information
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NPI Number | 1144472721
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Entity Type | Organization
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Legal Business Name | KINDRED SPIRIT
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Dates
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Enumeration Date | 10/15/2008
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Last Update Date | 10/15/2008
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Provider Practice Location Address
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Address Line | 2320 W DODGE RD
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City | CLIO
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State | MI
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Zip | 48420-1664
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Country | US
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Telephone | 810-686-1710
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Fax | 810-686-8939
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Provider Business Mailing Address
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Address Line | 2320 W DODGE RD
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City | CLIO
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State | MI
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Zip | 48420-1664
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Country | US
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Telephone | 810-686-1710
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Fax | 810-686-8939
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. LOIS MONTAGUE
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Credential |
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Telephone | 810-686-1710
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | AM250273429
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License Number State | MI
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