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General NPI Number Information
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NPI Number | 1033566567
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Entity Type | Organization
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Legal Business Name | SADIES LEISURE LIVING ADULT FAMILY HOME
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Dates
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Enumeration Date | 05/13/2016
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Last Update Date | 05/13/2016
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Provider Practice Location Address
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Address Line | 2800 W HOWARD AVE
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City | MILWAUKEE
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State | WI
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Zip | 53221-5814
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Country | US
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Telephone | 414-839-9146
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Fax |
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Provider Business Mailing Address
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Address Line | 9017 W WATERFORD SQ N
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City | GREENFIELD
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State | WI
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Zip | 53228-2242
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Country | US
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Telephone | 414-803-9966
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DEBRA RENA YOUNG
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Credential |
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Telephone | 414-803-9966
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 0016063
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License Number State | WI
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