| NPI | 1427878776 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELONIE L CAMPBELL Owner 262-321-9297 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Additional Taxonomies | 251S00000X |
| 253Z00000X In Home Supportive Care | |
| 261QD1600X Clinic/Center, Developmental Disabilities | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 385H00000X Respite Care | |
| Enumeration Date | 2024-10-11 |
| Last Update Date | 2024-10-11 |