Healthcare Provider Details

I. General information

NPI: 1831012491
Provider Name (Legal Business Name): HOMES FOR ALTERNATIVE LIVING OF WISCONSIN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

813 FAIRMONT AVE
MADISON WI
53714-1112
US

IV. Provider business mailing address

813 FAIRMONT AVE
MADISON WI
53714-1112
US

V. Phone/Fax

Practice location:
  • Phone: 202-888-9025
  • Fax: 608-821-0824
Mailing address:
  • Phone: 202-888-9025
  • Fax: 608-821-0824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: N DANISH
Title or Position: VICE PRESIDENT
Credential: MSI
Phone: 202-888-9025