| NPI | 1912157223 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY KINGSTON CEO 262-544-0687 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251E00000X Home Health |
| Additional Taxonomies | 251C00000X |
| 251S00000X Community/Behavioral Health | |
| 347C00000X Private Vehicle | |
| Enumeration Date | 2008-09-23 |
| Last Update Date | 2008-09-23 |