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Tawana D Lyons
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Racine, Wisconsin
NPI 1558068874

Tawana D Lyons is a Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility based in Racine, WI. Tawana D Lyons practices in Racine, WI. The NPI Number for Tawana D Lyons is 1558068874 and holds a License No. 0018876 (Wisconsin).

The current practice location address for Tawana D Lyons is 2332 Gilson St, Racine, WI and can be reached out via phone at 262-800-1032.

Location: 2332 Gilson St, Racine, WI, 53403-3010
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1558068874
Provider Name
Tawana D Lyons
Credential
Provider Entity Type
Individual
Gender
Female
Address
2332 Gilson St, Racine, WI, 53403-3010
Phone Number
262-800-1032
Fax Number
Provider Enumeration Date
02/08/2023
Last Update Date
03/10/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
PROV0002293446 01 WI DHS
0002293446 01 WI IRS
institution
Provider Business Practice Location Address Details
Address
2332 Gilson St
City
Racine
State
Wisconsin
Zip
53403-3010
Phone Number
262-800-1032
Fax Number
person
Provider Business Mailing Address Details
Address
2332 Gilson St
City
Racine
State
Wisconsin
Zip
53403-3010
Phone Number
262-800-1032
Fax Number
person
Provider's Taxonomy Details 1
Type
Residential Treatment Facilities
Classification
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Speciality
-
Taxonomy
320900000X
License No.
0018876 (Wisconsin)
Definition
A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with intellectual and/or developmental disabilities.
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