| NPI | 1164739934 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARLY JEAN BAKER Lpn 608-792-2646 |
| Organization Subpart ? | No |
| Primary Taxonomy | 385HR2060X Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child (Licence: WI 302971-031) |
| Enumeration Date | 2010-09-01 |
| Last Update Date | 2010-09-01 |