| NPI | 1164673133 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELZORA DARLENE COLLINS Executive Director 414-264-4217 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 251S00000X (Licence: WI 2473) |
| 291U00000X Clinical Medical Laboratory (Licence: WI 52D2043078) | |
| Enumeration Date | 2008-10-08 |
| Last Update Date | 2023-06-21 |