Healthcare Provider Details

I. General information

NPI: 1003771072
Provider Name (Legal Business Name): MILWAUKEE HAPPY HOUSE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2025
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2811 N PALMER ST
MILWAUKEE WI
53212-2435
US

IV. Provider business mailing address

2107 N 36TH ST
MILWAUKEE WI
53208-1406
US

V. Phone/Fax

Practice location:
  • Phone: 414-460-3523
  • Fax:
Mailing address:
  • Phone: 414-460-3523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: SHALANDA GREEN
Title or Position: OWNER
Credential:
Phone: 414-460-3523