Organization
GLORIA AWEKE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GLORIA AWEKE (RN)
(608) 834-1473
Entity
Organization
Contact information
Practice address
1111 GAS LIGHT DR, SUN PRAIRIE, WI 53590-3459
(608) 834-1473
Mailing address
1111 GAS LIGHT DR, SUN PRAIRIE, WI 53590-3459
(608) 834-1473
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
167973-30
WI
320700000X
Physical Disabilities Residential Treatment Facility
Primary
167973-30
WI
Other
Enumeration date
02/08/2012
Last updated
02/08/2012
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