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General NPI Number Information
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NPI Number | 1174930960
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Entity Type | Organization
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Legal Business Name | SURE CARE ASSISTED LIVING
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Dates
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Enumeration Date | 07/14/2014
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Last Update Date | 07/14/2014
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Provider Practice Location Address
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Address Line | 3710 N 39TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53216-3068
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Country | US
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Telephone | 414-339-0532
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Fax |
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Provider Business Mailing Address
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Address Line | 3710 N 39TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53216-3068
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. MELVIN EARL GRISBY
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Credential |
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Telephone | 414-339-0532
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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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