OrganizationActive
Match
NPI 1336205855 · Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Milwaukee, WI
Provider details
- NPI number
- 1336205855
- Entity type
- Organization
- Primary specialty
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityResidential Treatment Facilities
- Organization subpart
- No
- Authorized official
- Merry Kyles, Owner(414) 372-0739
- License
- 9374 (WI)
Specialties & taxonomies
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityPrimary320900000XLicense 9374 (WI)
Residential Treatment Facilities
Practice location
2902 N 1st St
Milwaukee, WI 53212-2406
Phone: (414) 372-0739
Fax: (414) 372-0739
Approximate (ZIP-level) locationGet directions
Mailing address
2902 N 1st St
Milwaukee, WI 53212-2406
Other names (DBA / former)
- Other name
- Match II
Registry dates
- Enumerated
- 2006-12-29
- Last updated
- 2020-08-22
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.