| NPI | 1215375472 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARCIA MARIE LEASER Substance Abuse Counselor 608-577-3112 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: WI 115813-131) |
| Enumeration Date | 2013-06-10 |
| Last Update Date | 2013-06-10 |