| NPI | 1740039254 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY ALAN FREY Owner 920-694-1102 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2024-05-16 |
| Last Update Date | 2024-05-16 |