Sumac Residential LLC

NPI #1912214966 in Hudson, Wisconsin

Provider Information

NPI Number: 1912214966
Entity Type: Organization
Organization Name: Sumac Residential LLC
Primary Specialty: Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Enumeration Date: Sep 10, 2010
Last Updated: Sep 10, 2010

Practice Location

Address: 723 B BLUE JAY LANE
City: Hudson
State: Wisconsin
ZIP Code: 54016
Phone: (715) 255-0466

Authorized Official

Name: MR. TIMOTHY RUSK
Title: OWNER
Phone: (715) 255-0466

Specialties & Taxonomy Codes

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

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