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Organization

STONEBRICK RESIDENTIAL LIVING FACILITY LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. KHALIO BORUM (FACILITY ADMINISTRATOR)
(414) 839-9906
Entity
Organization

Contact information

Practice address
4703 W VILLARD AVE, MILWAUKEE, WI 53218-4459
(414) 839-9906
(414) 435-0543
Mailing address
4703 W VILLARD AVE, MILWAUKEE, WI 53218-4459
(414) 839-9906
(414) 435-0543

Taxonomy

Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
WI

Other

Enumeration date
02/01/2016
Last updated
02/01/2016
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