Healthcare Provider Details

I. General information

NPI: 1417571050
Provider Name (Legal Business Name): KAAK LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2020
Last Update Date: 05/29/2020
Certification Date: 05/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5938 N 76TH STREET
MILWAUKEE WI
53218
US

IV. Provider business mailing address

11413 N MEADOWBROOK DR
MEQUON WI
53097-3136
US

V. Phone/Fax

Practice location:
  • Phone: 414-406-4392
  • Fax: 414-488-2311
Mailing address:
  • Phone: 414-406-4392
  • Fax: 414-488-2311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. LAZANDA D MOORE
Title or Position: OWNER/DIRECTOR
Credential:
Phone: 414-406-4392