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General NPI Number Information
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NPI Number | 1750917589
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Entity Type | Organization
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Legal Business Name | LOVING ELDERLY ADULT DAY CARE CENTER LLC
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Dates
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Enumeration Date | 03/12/2020
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Last Update Date | 03/12/2020
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Provider Practice Location Address
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Address Line | 7017 N 58TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53223-5204
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Country | US
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Telephone | 414-207-6796
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Fax |
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Provider Business Mailing Address
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Address Line | 7017 N 58TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53223-5204
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Country | US
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Telephone | 414-207-6796
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NCAIS THAO VANG
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Credential |
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Telephone | 414-243-5745
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TM1800X
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Taxonomy Name | Intellectual & Developmental Disabilities Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TA0700X
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Taxonomy Name | Adult Development & Aging Psychologist
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License Number |
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License Number State |
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