| NPI | 1154869410 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATASHA JACKSON Lpn 414-517-2825 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3140N1450X Skilled Nursing Facility, Nursing Care, Pediatric (Licence: WI 317445-31) |
| Enumeration Date | 2017-02-07 |
| Last Update Date | 2017-02-07 |