Healthcare Provider Details

I. General information

NPI: 1639083793
Provider Name (Legal Business Name): PEACEFUL POINT ADULT FAMILY HOME LLC
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

6929 W PIONEER RD
MEQUON WI
53097-1418
US

IV. Provider business mailing address

6929 W PIONEER RD
MEQUON WI
53097-1418
US

V. Phone/Fax

Practice location:
  • Phone: 262-330-4519
  • Fax:
Mailing address:
  • Phone: 262-330-4519
  • 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: MILDRED ADAMS
Title or Position: OWNER
Credential:
Phone: 262-330-4519