| NPI | 1508573486 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERESA JACKSON Owner 414-416-5749 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Additional Taxonomies | 251B00000X Case Management |
| Enumeration Date | 2022-11-01 |
| Last Update Date | 2025-06-18 |