MEDICARE: NEW HOPE ADULT COMMUNITY CENTER

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	0014754	WI

General Provider Information

NPI Number	:	1528568102
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW HOPE ADULT COMMUNITY CENTER

Provider Business Mailing Address
First Line	:	2433 W ROOSEVELT DR
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53209-6640
Country	:	US
Telephone Number	:	414-871-0350
Fax Number	:	414-871-4219

Provider Business Practice Location Address
First Line	:	2433 W ROOSEVELT DR
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53209-6640
Country	:	US
Telephone Number	:	414-871-0350
Fax Number	:	414-871-4219

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MARY L JACKSON
Credential	:	LPN
Telephone Number	:	414-871-0350

Provider Enumeration Date	:	02/20/2018
Last Update Date	:	02/20/2018

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Directions to “NEW HOPE ADULT COMMUNITY CENTER ” Practice Location

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