=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215805981
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FIRST CLASS CARE WISCONSIN LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2025
-----------------------------------------------------
Last Update Date | 10/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5441 N 73RD ST
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53218-2826
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-763-2072
-----------------------------------------------------
Fax | 414-897-7092
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5441 N 73RD ST
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53218-2826
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-763-2072
-----------------------------------------------------
Fax | 414-897-7092
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CEO
-----------------------------------------------------
Name | DANI ORUGBANI
-----------------------------------------------------
Credential | MR
-----------------------------------------------------
Telephone | 414-763-2072
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 311ZA0620X
-----------------------------------------------------
Taxonomy Name | Adult Care Home Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------