Organization
MENTOR ABI
Active
Other names
NeuroRestorative Wisconsin
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHRIS CUTLER (CFO)
(618) 457-4729
Entity
Organization
Contact information
Practice address
5310 BUENA PARK RD, WATERFORD, WI 53185-2907
(262) 534-4864
(262) 546-0801
Mailing address
10150 HIGHLAND MANOR DR STE 140, TAMPA, FL 33610-9712
(813) 626-1444
(813) 902-6719
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
0013091
WI
Other
Enumeration date
12/23/2010
Last updated
12/23/2010
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