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Organization
ST ROSE YOUTH & FAMILY CENTER INC
Active
Organization
ST ROSE YOUTH & FAMILY CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA J WALDRON MSW (DIRECTOR OF TREATMENT AND COMM SVC)
(414) 466-9450
Entity
Organization
Contact information
Practice address
3801 N 88TH ST, MILWAUKEE, WI 53222-2706
(414) 466-9450
(414) 466-0730
Mailing address
3801 N 88TH ST, MILWAUKEE, WI 53222-2706
(414) 466-9450
(414) 466-0730
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
265012
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
43017200
—
WI
Enumeration date
05/16/2008
Last updated
05/16/2008
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