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General NPI Number Information
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NPI Number | 1073407599
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Entity Type | Organization
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Legal Business Name | HERITAGE ON HAMPTON ASSISTED LIVING FACILITY LLC
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Dates
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Enumeration Date | 06/07/2025
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Last Update Date | 06/07/2025
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Provider Practice Location Address
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Address Line | 4615 W HAMPTON AVE
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City | MILWAUKEE
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State | WI
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Zip | 53218-5236
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Country | US
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Telephone | 414-803-7493
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Fax | 262-364-2048
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Provider Business Mailing Address
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Address Line | 11118 W MEINECKE AVE APT 6
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City | WAUWATOSA
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State | WI
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Zip | 53226-1248
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Country | US
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Telephone | 414-803-7493
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Fax | 262-364-2048
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Authorized Official
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Title or Position | MEMBER
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Name | MARIO KIMBROUGH
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Credential |
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Telephone | 414-803-7493
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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 |
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License Number State |
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