Healthcare Provider Details

I. General information

NPI: 1801717475
Provider Name (Legal Business Name): ABIDE SUPPORTIVE LIVING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9235 W CAPITOL DR STE 200
MILWAUKEE WI
53222-1567
US

IV. Provider business mailing address

9235 W CAPITOL DR STE 200
MILWAUKEE WI
53222-1567
US

V. Phone/Fax

Practice location:
  • Phone: 414-285-1630
  • Fax:
Mailing address:
  • Phone: 414-285-1630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. KEANA SPENCER
Title or Position: OWNER
Credential:
Phone: 414-285-1630