Healthcare Provider Details

I. General information

NPI: 1417803099
Provider Name (Legal Business Name): V&R ADULT FAMILY HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2026
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3211 N 3RD ST
MILWAUKEE WI
53212-2023
US

IV. Provider business mailing address

3211 N 3RD ST
MILWAUKEE WI
53212-2023
US

V. Phone/Fax

Practice location:
  • Phone: 414-837-0353
  • Fax:
Mailing address:
  • Phone: 414-837-0353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: DONNA JACKSON
Title or Position: OWNER
Credential: LPN
Phone: 414-628-5102