Oconomowoc Development Training Center Ll

NPI #1386977965 in Dousman, Wisconsin

Provider Information

NPI Number: 1386977965
Entity Type: Organization
Organization Name: Oconomowoc Development Training Center Ll
Subpart: Yes (part of a larger organization)
Parent Organization: OCONOMOWOC DEVELOPMENT TRAINING CENTER LLC
Primary Specialty: Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Enumeration Date: Sep 14, 2009
Last Updated: Sep 14, 2009

Practice Location

Address: 307 WILSON AVE.
City: Dousman
State: Wisconsin
ZIP Code: 53118
Phone: (262) 569-5515

Authorized Official

Name: MS. M. DEBORAH FRISK, MSW
Title: VICE PRESIDENT
Phone: (262) 569-5515

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Residential Treatment Facility, Intellectual and/or Developmental Disabilities	320600000X	Primary

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