Healthcare Provider Details

I. General information

NPI: 1679407076
Provider Name (Legal Business Name): KOSY ENTERPRISE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4224 N 53RD ST
MILWAUKEE WI
53216-1343
US

IV. Provider business mailing address

4224 N 53RD ST
MILWAUKEE WI
53216-1343
US

V. Phone/Fax

Practice location:
  • Phone: 414-313-3110
  • Fax: 414-313-3110
Mailing address:
  • Phone: 414-313-3110
  • Fax: 414-313-3110

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: BRANDY NICOLE JONES
Title or Position: ADMINISTRATOR
Credential:
Phone: 414-313-3110