Provider Demographics
NPI:1477737963
Name:CRU GROUP HOME, INC.
Entity Type:Organization
Organization Name:CRU GROUP HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GALINA
Authorized Official - Middle Name:
Authorized Official - Last Name:DONETS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-324-9754
Mailing Address - Street 1:9316 N WAVERLY DR
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-1341
Mailing Address - Country:US
Mailing Address - Phone:414-324-9754
Mailing Address - Fax:414-247-3764
Practice Address - Street 1:9316 N WAVERLY DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53217-1341
Practice Address - Country:US
Practice Address - Phone:414-324-9754
Practice Address - Fax:414-247-3764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility