| NPI | 1629345632 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANTONIA A VANN CEO 414-875-1511 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: WI 2239) |
| Additional Taxonomies | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: WI 2239) |
| Enumeration Date | 2011-11-18 |
| Last Update Date | 2011-11-18 |