Healthcare Provider Details

I. General information

NPI: 1902695596
Provider Name (Legal Business Name): BEYOND INFINITY ADULT FAMILY HOME, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2025
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3803 N 23RD ST
MILWAUKEE WI
53206-1915
US

IV. Provider business mailing address

4431 N 57TH ST
MILWAUKEE WI
53218-5609
US

V. Phone/Fax

Practice location:
  • Phone: 414-469-9108
  • Fax: 414-210-3149
Mailing address:
  • Phone: 414-469-9108
  • Fax: 414-210-3149

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 Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State

VIII. Authorized Official

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