=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336094879
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MONARCH SUPPORTIVE SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/02/2026
-----------------------------------------------------
Last Update Date | 03/02/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8720 N DEERWOOD DR APT 313
-----------------------------------------------------
City | BROWN DEER
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53209-1324
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-890-2204
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8720 N DEERWOOD DR APT 313
-----------------------------------------------------
City | BROWN DEER
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53209-1324
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-890-2204
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JESSICA LUSHELLE ADEBOWALE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 708-890-2204
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 320800000X
-----------------------------------------------------
Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------