Healthcare Provider Details

I. General information

NPI: 1235928219
Provider Name (Legal Business Name): TIFFANY JOHNSON LLC GINGERBREAD HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2025
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1906 N 35TH ST
MILWAUKEE WI
53208-1923
US

IV. Provider business mailing address

1906 N 35TH ST
MILWAUKEE WI
53208-1923
US

V. Phone/Fax

Practice location:
  • Phone: 414-509-5097
  • Fax: 414-296-0057
Mailing address:
  • Phone: 414-509-5097
  • Fax: 414-296-0057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State

VIII. Authorized Official

Name: MRS. TIFFANY JOHNSON
Title or Position: CEO
Credential:
Phone: 404-804-0311