| NPI | 1477314854 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID M DEROSIER Credentialing Specialist 262-548-8431 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2024-01-22 |
| Last Update Date | 2024-02-02 |