Healthcare Provider Details

I. General information

NPI: 1457171282
Provider Name (Legal Business Name): NEW LIFE NEW LOVE ADULT FAMILY HOME, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2024
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 N 24TH PL
MILWAUKEE WI
53205-1018
US

IV. Provider business mailing address

6324 RIVER PKWY
WAUWATOSA WI
53213-1129
US

V. Phone/Fax

Practice location:
  • Phone: 414-779-6344
  • Fax:
Mailing address:
  • Phone: 414-779-6344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SHAKEYA WILLIAMSON
Title or Position: OWNER
Credential:
Phone: 414-779-6344