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General NPI Number Information
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NPI Number | 1174330666
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Entity Type | Organization
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Legal Business Name | E & A ADULT FAMILY HOME LLC MILKY WAY
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Dates
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Enumeration Date | 12/17/2024
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Last Update Date | 12/17/2024
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Provider Practice Location Address
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Address Line | 726 MILKY WAY
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City | MADISON
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State | WI
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Zip | 53718-2920
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Country | US
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Telephone | 608-598-7849
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Fax |
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Provider Business Mailing Address
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Address Line | 726 MILKY WAY
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City | MADISON
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State | WI
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Zip | 53718-2920
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Country | US
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Telephone | 608-598-7849
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | EBRIMA JARJU
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Credential |
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Telephone | 608-598-7849
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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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