| NPI | 1912464934 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACOB PATRICK JANSEN Owner/Executive Director 262-290-1072 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2019-02-26 |
| Last Update Date | 2019-02-26 |