| NPI | 1386789535 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARCIA LARSON Executive Director 920-231-0143 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: WI 1710) |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2020-08-22 |