| NPI | 1518556158 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ZAKKIYYA FAHMEEDA SALAHADYN Owner Operator 414-676-4381 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2021-01-17 |
| Last Update Date | 2021-01-17 |