| NPI | 1245628817 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES GREEN Executive Director 414-617-1801 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261Q00000X |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: WI 3059) |
| Enumeration Date | 2015-01-05 |
| Last Update Date | 2015-01-05 |