=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699135814
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARING HANDS ADULT FAMILY CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/01/2016
-----------------------------------------------------
Last Update Date | 03/01/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4043 N 68TH ST
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53216-1112
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-763-9990
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11114 W MEADOW CREEK DR
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53224-5053
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-704-1294
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | JAMIA D LOWE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 414-704-1294
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | 0015871
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------