Healthcare Provider Details

I. General information

NPI: 1114830205
Provider Name (Legal Business Name): DONSONS FAMILY LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6526 22ND AVE
KENOSHA WI
53143-1218
US

IV. Provider business mailing address

6526 22ND AVE
KENOSHA WI
53143-1218
US

V. Phone/Fax

Practice location:
  • Phone: 414-759-9578
  • Fax:
Mailing address:
  • Phone: 414-759-9578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateNULL

VIII. Authorized Official

Name: JYRON DONSON
Title or Position: OWNER
Credential:
Phone: 414-759-9578