| NPI | 1831974955 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WANDA BOONE Director 262-853-1344 |
| Organization Subpart ? | No |
| Primary Taxonomy | 310500000X Intermediate Care Facility, Mental Illness |
| Additional Taxonomies | 251J00000X Nursing Care |
| 313M00000X Nursing Facility/Intermediate Care Facility | |
| 3140N1450X Skilled Nursing Facility, Nursing Care, Pediatric | |
| Enumeration Date | 2023-08-28 |
| Last Update Date | 2023-08-28 |