| NPI | 1003670977 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DESSA BEARDEN Program Director 262-221-8524 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3104A0630X Assisted Living Facility, Assisted Living, Behavioral Disturbances |
| Additional Taxonomies | 310400000X Assisted Living Facility |
| Enumeration Date | 2024-02-09 |
| Last Update Date | 2024-02-09 |