Healthcare Provider Details

I. General information

NPI: 1366890196
Provider Name (Legal Business Name): ASSISTED DAILY LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2016
Last Update Date: 06/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 N WAVERLY PL. STE. 503
MILWAUKEE WI
53202-3475
US

IV. Provider business mailing address

1121 N WAVERLY PL. STE 503
MILWAUKEE WI
53202-3475
US

V. Phone/Fax

Practice location:
  • Phone: 414-271-5500
  • Fax: 414-221-0507
Mailing address:
  • Phone: 414-271-5500
  • Fax: 414-221-0507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. GLENN EDWARD JOHNSTON
Title or Position: ADMINISTRATOR
Credential:
Phone: 414-271-5500