| NPI | 1144400383 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMBER RADULOVICH Billing Manager 414-445-0997 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: WI 2685) |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: WI 2685) |
| Enumeration Date | 2007-11-05 |
| Last Update Date | 2018-07-13 |