Healthcare Provider Details

I. General information

NPI: 1124933965
Provider Name (Legal Business Name): INDIGO FAMILY HOMES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 3RD AVE
GRAFTON WI
53024-1708
US

IV. Provider business mailing address

1044 3RD AVE
GRAFTON WI
53024-1708
US

V. Phone/Fax

Practice location:
  • Phone: 414-275-5460
  • Fax:
Mailing address:
  • Phone: 414-275-5460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: AALIYAH SAMPSON
Title or Position: OWNER
Credential:
Phone: 414-275-5460