Healthcare Provider Details

I. General information

NPI: 1659295202
Provider Name (Legal Business Name): SUNRISE HAVEN ADULT FAMILY HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4475 N 40TH ST
MILWAUKEE WI
53209-5805
US

IV. Provider business mailing address

4475 N 40TH ST
MILWAUKEE WI
53209-5805
US

V. Phone/Fax

Practice location:
  • Phone: 414-839-1183
  • 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: NIVIA DAVIS-FRECHETTE
Title or Position: OWNER
Credential:
Phone: 414-578-0871