| NPI | 1114415908 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PETER BRUNZELLE Executive Director 262-420-9088 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2018-04-26 |
| Last Update Date | 2023-05-22 |