=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487466322
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMORE'S WAY ADULT FAMILY HOME
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/27/2025
-----------------------------------------------------
Last Update Date | 01/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1926 DEANE BLVD
-----------------------------------------------------
City | RACINE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53403-2354
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-456-2196
-----------------------------------------------------
Fax | 262-686-4566
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1926 DEANE BLVD
-----------------------------------------------------
City | RACINE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53403-2354
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-456-2196
-----------------------------------------------------
Fax | 262-686-4566
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-OWNER
-----------------------------------------------------
Name | MRS. TERMERIA IRBY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 847-736-7333
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 311ZA0620X
-----------------------------------------------------
Taxonomy Name | Adult Care Home Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------