Healthcare Provider Details

I. General information

NPI: 1730068719
Provider Name (Legal Business Name): BEYOND INFINITY ADULT FAMILY HOME, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2025
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2559 N 49TH ST
MILWAUKEE WI
53210-2848
US

IV. Provider business mailing address

3803 N 23RD ST
MILWAUKEE WI
53206-1915
US

V. Phone/Fax

Practice location:
  • Phone: 414-469-9108
  • Fax: 414-438-9108
Mailing address:
  • Phone: 414-469-9108
  • Fax: 414-438-9108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. GENTELLA D WEARY
Title or Position: MANAGER/OWNER
Credential:
Phone: 414-469-9108