Organization
LILLIE HOUSE
Active
Other names
Lifes Vision LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LES L HIGGENBOTTOM LCSW, CSAC (PSYCHOTHERAPIST)
(414) 732-4253
Entity
Organization
Contact information
Practice address
4618 KINZIE AVE, RACINE, WI 53405-2212
(262) 634-6781
Mailing address
4618 KINZIE AVE, RACINE, WI 53405-2212
(262) 634-6781
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
—
WI
Other
Enumeration date
07/21/2008
Last updated
07/21/2008
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