Healthcare Provider Details

I. General information

NPI: 1669648242
Provider Name (Legal Business Name): KENOSHA AREA FAMILY AND AGING SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2008
Last Update Date: 05/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7730 SHERIDAN RD
KENOSHA WI
53143-1518
US

IV. Provider business mailing address

7730 SHERIDAN RD
KENOSHA WI
53143-1518
US

V. Phone/Fax

Practice location:
  • Phone: 262-658-3508
  • Fax: 262-658-2263
Mailing address:
  • Phone: 262-658-3508
  • Fax: 262-658-2263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. GARY G BROWN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 262-658-3508