| NPI | 1831464536 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS SHANE BOLAN Director 608-751-1042 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: WI 1023) |
| Enumeration Date | 2012-03-13 |
| Last Update Date | 2012-03-13 |