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General NPI Number Information
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NPI Number | 1134709561
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Entity Type | Organization
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Legal Business Name | LOVE OF GRACE ADULT SERVICES
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Dates
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Enumeration Date | 04/09/2021
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Last Update Date | 02/27/2026
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Provider Practice Location Address
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Address Line | 4556 N 41ST ST
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City | MILWAUKEE
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State | WI
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Zip | 53209-5818
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Country | US
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Telephone | 262-281-1574
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Fax |
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Provider Business Mailing Address
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Address Line | 4556 N 41ST ST
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City | MILWAUKEE
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State | WI
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Zip | 53209-5818
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Country | US
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Telephone | 262-281-1574
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. TAMIA M FREEMAN
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Credential |
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Telephone | 800-796-0419
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management 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 | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 311Z00000X
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Taxonomy Name | Custodial Care Facility
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License Number |
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License Number State |
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