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General NPI Number Information
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NPI Number | 1417571050
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Entity Type | Organization
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Legal Business Name | KAAK LIVING
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Dates
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Enumeration Date | 05/29/2020
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Last Update Date | 05/29/2020
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Provider Practice Location Address
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Address Line | 5938 N 76TH STREET
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City | MILWAUKEE
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State | WI
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Zip | 53218
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Country | US
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Telephone | 414-406-4392
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Fax | 414-488-2311
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Provider Business Mailing Address
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Address Line | 11413 N MEADOWBROOK DR
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City | MEQUON
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State | WI
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Zip | 53097-3136
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Country | US
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Telephone | 414-406-4392
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Fax | 414-488-2311
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | MS. LAZANDA D MOORE
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Credential |
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Telephone | 414-406-4392
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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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