MEDICARE: MANNAS HOUSE ADULT DAYCARE II, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1336790682
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MANNAS HOUSE ADULT DAYCARE II, INC

Provider Business Mailing Address
First Line	:	1034 WEST BLVD
Second Line	:
City	:	RACINE
State	:	WI
Zip	:	53405-2502
Country	:	US
Telephone Number	:	262-902-2420
Fax Number	:	262-583-0653

Provider Business Practice Location Address
First Line	:	1034 WEST BLVD
Second Line	:
City	:	RACINE
State	:	WI
Zip	:	53405-2502
Country	:	US
Telephone Number	:	262-902-2420
Fax Number	:	262-583-0653

Authorized Official
Title or Position	:	OWNER
Name	:	BEATRICE JOHNSON
Credential	:
Telephone Number	:	262-583-0653

Provider Enumeration Date	:	09/26/2019
Last Update Date	:	09/26/2019

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