| NPI | 1275417578 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAVON TUCKER Owner/Provider 414-322-4595 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2025-08-01 |
| Last Update Date | 2025-08-01 |