| NPI | 1457688863 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARTIN A GORDON Program Director 715-779-3741 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: WI 1781) |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility (Licence: WI 1781) |
| Enumeration Date | 2009-11-05 |
| Last Update Date | 2009-11-05 |