# SUMAC RESIDENTIAL LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Blue Jay Assisted Living
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912214966
- **Authorized official:** MR. TIMOTHY RUSK (OWNER)
- **Authorized official phone:** (715) 255-0466

## Contact information

- **Practice address:** 723 B BLUE JAY LANE, HUDSON, WI 54016
- **Practice address phone:** (715) 255-0466
- **Mailing address:** 723B BLUE JAY LN, HUDSON, WI 54016-7695
- **Mailing address phone:** (715) 255-0466

## Taxonomy

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

## Other

- **Enumeration date:** 09/10/2010
- **Last updated:** 09/10/2010