Healthcare Provider Details

I. General information

NPI: 1255266227
Provider Name (Legal Business Name): JOHNSON LOVE JOHNSON HOUSE OF PROSPERITY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4675 N 48TH ST
MILWAUKEE WI
53218-5120
US

IV. Provider business mailing address

5266 N 28TH ST
MILWAUKEE WI
53209-4943
US

V. Phone/Fax

Practice location:
  • Phone: 262-624-7585
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. CORA JOHNSON
Title or Position: OWNER
Credential: CMA, CDCP, CPT
Phone: 262-475-8593