Healthcare Provider Details

I. General information

NPI: 1275126740
Provider Name (Legal Business Name): NEVEAH HOUSE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2021
Last Update Date: 02/16/2021
Certification Date: 02/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4115 N 84TH ST
MILWAUKEE WI
53222-1813
US

IV. Provider business mailing address

4115 N 84TH ST
MILWAUKEE WI
53222-1813
US

V. Phone/Fax

Practice location:
  • Phone: 414-335-5542
  • Fax:
Mailing address:
  • Phone: 414-335-5542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: ADRIANA JEFFERSON
Title or Position: OWNER
Credential:
Phone: 414-335-5542