Healthcare Provider Details

I. General information

NPI: 1528568102
Provider Name (Legal Business Name): NEW HOPE ADULT COMMUNITY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2018
Last Update Date: 02/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2433 W ROOSEVELT DR
MILWAUKEE WI
53209-6640
US

IV. Provider business mailing address

2433 W ROOSEVELT DR
MILWAUKEE WI
53209-6640
US

V. Phone/Fax

Practice location:
  • Phone: 414-871-0350
  • Fax: 414-871-4219
Mailing address:
  • Phone: 414-871-0350
  • Fax: 414-871-4219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number0014754
License Number StateWI

VIII. Authorized Official

Name: MARY L JACKSON
Title or Position: DIRECTOR
Credential: LPN
Phone: 414-871-0350