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General NPI Number Information
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NPI Number | 1366269383
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Entity Type | Organization
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Legal Business Name | A&G ADULT DAYCARE LLC
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Dates
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Enumeration Date | 09/21/2024
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Last Update Date | 09/21/2024
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Provider Practice Location Address
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Address Line | 2416 W LISBON AVE
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City | MILWAUKEE
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State | WI
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Zip | 53205-1412
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Country | US
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Telephone | 414-531-6857
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Fax |
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Provider Business Mailing Address
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Address Line | 2463 N GRANT BLVD
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City | MILWAUKEE
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State | WI
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Zip | 53210-2941
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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 | PROGRAM DIRECTOR
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Name | GLORIA WREN
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Credential |
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Telephone | 414-531-6857
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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