Healthcare Provider Details

I. General information

NPI: 1720992332
Provider Name (Legal Business Name): AGAPE GENERATIONAL LIVING FACILITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4798 W WILLOW RD
BROWN DEER WI
53223-3652
US

IV. Provider business mailing address

4798 W WILLOW RD
BROWN DEER WI
53223-3652
US

V. Phone/Fax

Practice location:
  • Phone: 414-236-5021
  • Fax:
Mailing address:
  • Phone: 414-236-5021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateNULL

VIII. Authorized Official

Name: JENELLE M WARD
Title or Position: ADMINISTRATOR/NURSE PRACTITIONER
Credential: APRN
Phone: 262-454-2117