Healthcare Provider Details

I. General information

NPI: 1205475043
Provider Name (Legal Business Name): SENSATIONAL PARADISE ASSISTED LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2019
Last Update Date: 12/26/2019
Certification Date: 12/26/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4056 N 41ST ST
MILWAUKEE WI
53216-1606
US

IV. Provider business mailing address

4422 N 85TH ST
MILWAUKEE WI
53225-5108
US

V. Phone/Fax

Practice location:
  • Phone: 414-388-5492
  • Fax:
Mailing address:
  • Phone: 414-388-5492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: LACHELLE BROWN
Title or Position: OWNER
Credential:
Phone: 414-388-5492