NPI 1467810788

Stonebrick Residential Living Facility LLC

Organisation Intellectual and/or Developmental Disabilities Residential Treatment Facility Milwaukee, WI

Practice location

Address: 4703 W Villard Ave, Milwaukee, WI 53218-4459
Phone: (414) 839-9906
Fax: (414) 435-0543

Authorised official

Name: Khalio Borum
Title: Facility Administrator
Phone: (414) 839-9906

Registered specialties

Intellectual and/or Developmental Disabilities Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 320600000X

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Registry record

NPI: 1467810788
Entity type: Organization
NPI issued: 1 Feb 2016
Record last updated: 1 Feb 2016

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.