| NPI | 1932962487 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CANDACE SPEARS Authorized Rep. 262-202-1221 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 251C00000X Day Training, Developmentally Disabled Services |
| 251S00000X | |
| 253Z00000X In Home Supportive Care | |
| 276400000X Rehabilitation, Substance Use Disorder Unit | |
| 315P00000X Intermediate Care Facility, Intellectual Disabilities | |
| 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| 324500000X Substance Abuse Rehabilitation Facility | |
| 385HR2060X Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child | |
| Enumeration Date | 2024-02-06 |
| Last Update Date | 2024-02-06 |