Organization
INDIVIDUAL GROWTH SERIVCES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAWN PATRICK MILES (DIRECTOR)
(262) 284-9656
Entity
Organization
Contact information
Practice address
1000 N WISCONSIN ST, SUITE 5, PORT WASHINGTON, WI 53074-1285
(262) 284-9656
(262) 284-4590
Mailing address
1000 N WISCONSIN ST, SUITE 5, PORT WASHINGTON, WI 53074-1285
(262) 284-9656
(262) 284-4590
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
390237
WI
Other
Enumeration date
10/26/2015
Last updated
10/26/2015
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