| NPI | 1306635487 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PETER BRUNZELLE President 262-701-7257 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2025-05-05 |
| Last Update Date | 2025-05-05 |