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General NPI Number Information
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NPI Number | 1508713058
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Entity Type | Organization
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Legal Business Name | FLADAVY ADULT FAMILY HOME LLC
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Dates
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Enumeration Date | 03/13/2026
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Last Update Date | 03/13/2026
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Provider Practice Location Address
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Address Line | 1215 8TH ST E
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City | MENOMONIE
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State | WI
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Zip | 54751-2608
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Country | US
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Telephone | 651-303-9293
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Fax |
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Provider Business Mailing Address
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Address Line | 923 LONDONDERRY DR NW
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City | ROCHESTER
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State | MN
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Zip | 55901-3427
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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 | DAVID MOKAYA
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Credential |
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Telephone | 651-303-9293
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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