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General NPI Number Information
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NPI Number | 1043188329
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Entity Type | Organization
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Legal Business Name | LIVE IN COLOR SUPPORTIVE INDEPENDENT LIVING
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Dates
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Enumeration Date | 10/28/2025
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 4345 N 60TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53216-1209
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Country | US
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Telephone | 414-628-9205
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Fax |
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Provider Business Mailing Address
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Address Line | 8015 S MONA DR
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City | OAK CREEK
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State | WI
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Zip | 53154-3033
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Country | US
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Telephone | 414-628-9205
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | VERNISHA TAYLOR
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Credential |
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Telephone | 414-628-9205
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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