| NPI | 1902342058 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DERREK CARTER Executive Director 414-202-1974 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: WI 0016244) |
| Enumeration Date | 2017-01-12 |
| Last Update Date | 2017-01-12 |