NPI 1649574252

Mentor Abi

Organisation Mental Illness Community Based Residential Treatment Facility Waterford, WI

Practice location

Address: 5310 Buena Park Rd, Waterford, WI 53185-2907
Phone: (262) 534-4864
Fax: (262) 546-0801
Mailing address: 10150 Highland Manor Dr STE 140, Tampa, FL 33610-9712

Authorised official

Name: Chris Cutler
Title: Cfo
Phone: (618) 457-4729

Registered specialties

Mental Illness Community Based Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 320800000X Licence 0013091 (WI)

Other Community Based Residential Treatment Facility, Mental Illness providers in Wisconsin →

Registry record

NPI: 1649574252
Entity type: Organization
NPI issued: 23 Dec 2010
Record last updated: 23 Dec 2010

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.