| NPI | 1235302480 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY E CROOKS Quality Assurance Manager 608-663-2120 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: WI 774) |
| Enumeration Date | 2008-04-09 |
| Last Update Date | 2022-08-15 |