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Active
Organization subpart
No

Provider details

NPI number
Authorized official
PERCENIA MARIA COLEMAN (ADMINISTRATOR)
(646) 731-8198
Entity
Organization

Contact information

Practice address
7510 N 87TH ST, MILWAUKEE, WI 53224-4038
(646) 731-8198
Mailing address
7510 N 87TH ST, MILWAUKEE, WI 53224-4038
(646) 731-8198

Taxonomy

Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
320900000X
WI

Other

Enumeration date
04/24/2012
Last updated
04/24/2012
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