| NPI | 1669970729 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAMELA AHLBORN Compliance & Contract COO Rdinator 715-588-4422 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| 324500000X Substance Abuse Rehabilitation Facility (Licence: WI 3100) | |
| Enumeration Date | 2018-01-24 |
| Last Update Date | 2018-09-13 |