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General NPI Number Information
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NPI Number | 1295446912
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Entity Type | Organization
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Legal Business Name | HUMBLE LIVING HOME TWO
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Dates
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Enumeration Date | 12/13/2022
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Last Update Date | 12/13/2022
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Provider Practice Location Address
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Address Line | 923 TOWER LN
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City | WEST BEND
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State | WI
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Zip | 53090-2425
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Country | US
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Telephone | 262-239-1138
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Fax |
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Provider Business Mailing Address
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Address Line | 923 TOWER LN
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City | WEST BEND
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State | WI
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Zip | 53090-2425
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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 | OWNER
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Name | VERSHAUNDA CAMPBELL
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Credential |
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Telephone | 262-239-1138
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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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