| NPI | 1174992895 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANTONEO DESHAZOR Executive Director 414-793-3896 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2015-09-23 |
| Last Update Date | 2015-09-23 |