| NPI | 1053654392 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRYSTAL J MILLER Owner 262-925-9302 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: WI 0013446) |
| Enumeration Date | 2013-04-05 |
| Last Update Date | 2013-04-05 |