Healthcare Provider Details

I. General information

NPI: 1548172414
Provider Name (Legal Business Name): ROYAL LEGACY ADULT FAMILY HOME 2
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5530 N 92ND ST APT 2
MILWAUKEE WI
53225-3461
US

IV. Provider business mailing address

8535 W NORTH AVE
WAUWATOSA WI
53226-2814
US

V. Phone/Fax

Practice location:
  • Phone: 414-915-6323
  • Fax:
Mailing address:
  • Phone: 414-915-6323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. LADIAMA JOHNSON
Title or Position: OWNER
Credential:
Phone: 414-915-6323