Organization
ST. AEMILIAN-LAKESIDE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BRIDGET FASSETT (CHIEF FINANCIAL OFFICER)
(414) 465-1308
Entity
Organization
Contact information
Practice address
8901 W CAPITOL DR, MILWAUKEE, WI 53222-1706
(414) 465-1308
(414) 465-5788
Mailing address
8901 W CAPITOL DR, MILWAUKEE, WI 53222-1706
(414) 465-1308
(414) 465-5788
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
265011
WI
Other
Enumeration date
06/24/2010
Last updated
06/24/2010
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