| NPI | 1003064064 |
|---|---|
| Doing Business As | COMMUNITY BASED RESIDENTIAL FACILITY |
| Entity Type | Organization |
| Authorized Contact | SHIRLEY TEMPLE GLADNEY Administrator 414-445-3607 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QC1500X Clinic/Center Community Health |
| Enumeration Date | 2008-09-03 |
| Last Update Date | 2008-09-03 |