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General NPI Number Information
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NPI Number | 1770091431
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Entity Type | Organization
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Legal Business Name | KINGS ACADEMY
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Dates
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Enumeration Date | 01/16/2018
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Last Update Date | 12/23/2025
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Provider Practice Location Address
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Address Line | 1350 W RESERVOIR AVE
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City | MILWAUKEE
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State | WI
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Zip | 53205-1737
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Country | US
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Telephone | 414-585-9374
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Fax | 414-585-0398
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Provider Business Mailing Address
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Address Line | 1350 W RESERVOIR AVE
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City | MILWAUKEE
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State | WI
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Zip | 53205-1737
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Country | US
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Telephone | 414-585-9374
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Fax | 414-585-0398
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Authorized Official
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Title or Position | OWNER
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Name | SHIRLEY ANN KING
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Credential |
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Telephone | 414-248-2112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 0016450
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License Number State | WI
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