Organization
IMPACTHEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. YVETTE JOHNSON-TOWERS MSN, APRN (DIRECTOT)
(414) 771-0453
Entity
Organization
Contact information
Practice address
3219 N 51ST BLVD, MILWAUKEE, WI 53216-3235
(414) 771-0543
Mailing address
3219 N 51ST BLVD, MILWAUKEE, WI 53216-3235
(414) 771-0543
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
101528-30
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1073805255
—
WI
05
—
1104264001
—
WI
Enumeration date
12/18/2014
Last updated
12/18/2014
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