| NPI | 1336508613 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PETER T BRUNZELLE Executive Director 262-701-7257 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: WI 3129) |
| Additional Taxonomies | 251S00000X (Licence: WI 3129) |
| Enumeration Date | 2016-02-16 |
| Last Update Date | 2023-05-22 |