| NPI | 1134482557 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIA C SMITH Owner 414-426-5980 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: WI 0012482) |
| Enumeration Date | 2012-06-20 |
| Last Update Date | 2012-06-20 |