| NPI | 1508357146 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRYSTAL KOSTRIVAS Owner 262-565-8938 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: WA 200568) |
| Enumeration Date | 2018-05-18 |
| Last Update Date | 2018-05-18 |