| NPI | 1649661711 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TINA SANFORD Director 262-432-0670 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2015-02-11 |
| Last Update Date | 2023-09-12 |