Healthcare Provider Details

I. General information

NPI: 1588464085
Provider Name (Legal Business Name): HEAVEN'S CHOICE ADULT DAY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2025
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4734 W LISBON AVE
MILWAUKEE WI
53208-1127
US

IV. Provider business mailing address

4734 W LISBON AVE
MILWAUKEE WI
53208-1127
US

V. Phone/Fax

Practice location:
  • Phone: 414-635-0131
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: ERICA BROWN
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 414-628-1079