| NPI | 1578442042 |
|---|---|
| Doing Business As | EXECUTIVE DIRECTOR |
| Entity Type | Organization |
| Authorized Contact | CLEM L RICHARDSON Owner 414-240-1385 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2025-08-29 |
| Last Update Date | 2025-10-21 |