# OCONOMOWOC DEVEMOPMENTAL TRAINING CENTER LL

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** OCONOMOWOC DEVEMOPMENTAL TRAINING CENTER LLC
- **Other names:** Cory House Group Home
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1013240696
- **Legal business name:** OCONOMOWOC DEVEMOPMENTAL TRAINING CENTER LLC
- **Authorized official:** MS. M. DEBORAH FRISK MSW (VICE PRESIDENT)
- **Authorized official phone:** (262) 569-5515

## Contact information

- **Practice address:** 201-203 CORY AVE., DOUSMAN, WI 53118
- **Practice address phone:** (262) 569-5515
- **Practice address fax:** (262) 569-9962
- **Mailing address:** PO BOX 278, DOUSMAN, WI 53118
- **Mailing address phone:** (262) 569-5515
- **Mailing address fax:** (262) 569-9962

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | — | WI | Yes |

## Other

- **Enumeration date:** 09/14/2009
- **Last updated:** 09/14/2009