| NPI | 1144687740 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK JUSTIN BERTRAND Co Owner 920-205-1087 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: WI 2239-57) |
| Enumeration Date | 2016-01-27 |
| Last Update Date | 2016-01-27 |