Healthcare Provider Details

I. General information

NPI: 1659553121
Provider Name (Legal Business Name): BETTER LIVING GROUP HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2007
Last Update Date: 11/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4115 N 36TH ST
MILWAUKEE WI
53210
US

IV. Provider business mailing address

4115 N 56TH ST SUITE B,188
MILWAUKEE WI
53216-1269
US

V. Phone/Fax

Practice location:
  • Phone: 414-871-1515
  • Fax: 414-871-1503
Mailing address:
  • Phone: 414-871-1515
  • Fax: 414-871-1503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number StateWI
# 5
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number StateWI
# 6
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number StateWI
# 7
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateWI
# 8
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateWI

VIII. Authorized Official

Name: MR. THOMAS SMITH
Title or Position: CEO/OWNER
Credential:
Phone: 414-975-5971