| NPI | 1902085624 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY A. FREY President 920-457-0826 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: WI 11183) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: WI 9340) | |
| Enumeration Date | 2007-10-30 |
| Last Update Date | 2023-12-27 |