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Active
Organization subpart
No

Provider details

NPI number
Authorized official
ANDIE ELLIS (ADMINISTRATOR)
(715) 447-5574
Entity
Organization

Contact information

Practice address
N3531 ELDER DR, GILMAN, WI 54433
(715) 447-5574
Mailing address
N3531 ELDER DR, GILMAN, WI 54433-9608

Taxonomy

Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
0013267
WI

Other

Enumeration date
02/25/2013
Last updated
02/25/2013
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