| NPI | 1336690833 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | QIANA CLARK Owner 414-469-0520 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2016-10-19 |
| Last Update Date | 2016-10-19 |