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General NPI Number Information
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NPI Number | 1720992332
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Entity Type | Organization
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Legal Business Name | AGAPE GENERATIONAL LIVING FACILITY LLC
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Dates
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Enumeration Date | 09/30/2026
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Last Update Date | 09/30/2026
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Provider Practice Location Address
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Address Line | 4798 W WILLOW RD
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City | BROWN DEER
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State | WI
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Zip | 53223-3652
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Country | US
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Telephone | 414-236-5021
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Fax |
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Provider Business Mailing Address
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Address Line | 4798 W WILLOW RD
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City | BROWN DEER
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State | WI
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Zip | 53223-3652
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Country | US
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Telephone | 414-236-5021
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR/NURSE PRACTITIONER
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Name | JENELLE M WARD
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Credential | APRN
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Telephone | 262-454-2117
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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 | NULL
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Taxonomy #2
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State | NULL
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