Organization
RESCARE RESIDENTAIL SERVICES WISCONSIN, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGIE MATTINGLY (MGR PROVIDER ENROLLMENT)
(502) 394-2100
Entity
Organization
Contact information
Practice address
540 VILLAGE WALK LN STE C, JOHNSON CREEK, WI 53038-9554
(920) 261-3050
Mailing address
805 N WHITTINGTON PKWY, LOUISVILLE, KY 40222-7101
(502) 394-2100
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
08/21/2017
Last updated
04/10/2024
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