Healthcare Provider Details

I. General information

NPI: 1740093913
Provider Name (Legal Business Name): ONE BIG FAMILY ADULT FAMILY HOMES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2025
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 GARFIELD ST
BURLINGTON WI
53105-2040
US

IV. Provider business mailing address

316 GARFIELD ST
BURLINGTON WI
53105-2040
US

V. Phone/Fax

Practice location:
  • Phone: 262-806-7252
  • Fax: 419-781-4255
Mailing address:
  • Phone: 262-806-7252
  • Fax: 419-781-4255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH ANN BALL
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 262-806-7252