| NPI | 1679163109 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL MINNING Controller 920-206-4459 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| Enumeration Date | 2021-01-19 |
| Last Update Date | 2021-01-19 |