Healthcare Provider Details

I. General information

NPI: 1346362639
Provider Name (Legal Business Name): BURRIS ADULT FAMILY HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5249 N 37TH STREET
MILWAUKEE WI
53209-4727
US

IV. Provider business mailing address

5249 NO 37TH STREET
MILWAUKEE WI
53209-4727
US

V. Phone/Fax

Practice location:
  • Phone: 414-810-3237
  • Fax: 414-810-3237
Mailing address:
  • Phone: 414-810-3237
  • Fax: 414-810-3237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License NumberSTATE LICENSE
License Number StateWI

VIII. Authorized Official

Name: MR. DONALD L BURRIS
Title or Position: OWNER
Credential:
Phone: 414-810-3237