MEDICARE: HOUSE OF PURPOSE

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	251300000X	Local Education Agency (LEA)
2	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1902611841
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOUSE OF PURPOSE

Provider Business Mailing Address
First Line	:	2975 RIVER BIRCH DR UNIT F
Second Line	:
City	:	BROOKFIELD
State	:	WI
Zip	:	53045-3491
Country	:	US
Telephone Number	:	414-607-2662
Fax Number	:

Provider Business Practice Location Address
First Line	:	2772 N MLK DR STE 106
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53212-2312
Country	:	US
Telephone Number	:	414-607-2662
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LONDELL DALLAS
Credential	:
Telephone Number	:	414-607-2662

Provider Enumeration Date	:	02/10/2025
Last Update Date	:	02/10/2025

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Directions to “HOUSE OF PURPOSE ” Practice Location

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