| NPI | 1245502053 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLORIA AWEKE RN 608-834-1473 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320700000X Residential Treatment Facility, Physical Disabilities (Licence: WI 167973-30) |
| Additional Taxonomies | 320600000X Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities (Licence: WI 167973-30) |
| Enumeration Date | 2012-02-08 |
| Last Update Date | 2012-02-08 |