| NPI | 1578098208 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRENA LOOMANS Director Of Clinical Operations 715-301-0667 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2017-05-01 |
| Last Update Date | 2019-09-13 |