MEDICARE: HOLY PROPERTIES LLC

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	311ZA0620X	Adult Care Home Facility		WI

General Provider Information

NPI Number	:	1790155091
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLY PROPERTIES LLC

Provider Business Mailing Address
First Line	:	6324 W FOND DU LAC AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53218-4906
Country	:	US
Telephone Number	:	414-446-4077
Fax Number	:	844-273-9397

Provider Business Practice Location Address
First Line	:	6324 W FOND DU LAC AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53218-4906
Country	:	US
Telephone Number	:	414-446-4077
Fax Number	:	844-273-9397

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. JULETTE FRANCIS-WADE
Credential	:
Telephone Number	:	414-466-4077

Provider Enumeration Date	:	09/29/2015
Last Update Date	:	09/29/2015

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Directions to “HOLY PROPERTIES LLC ” Practice Location

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