MEDICARE: ANASTASIA CARE HOME LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1003761156
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANASTASIA CARE HOME LLC

Provider Business Mailing Address
First Line	:	17620 BOLTER LN
Second Line	:
City	:	BROOKFIELD
State	:	WI
Zip	:	53045-3431
Country	:	US
Telephone Number	:	414-410-9850
Fax Number	:

Provider Business Practice Location Address
First Line	:	17620 BOLTER LN
Second Line	:
City	:	BROOKFIELD
State	:	WI
Zip	:	53045-3431
Country	:	US
Telephone Number	:	414-410-9850
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	QUINTA NFOR
Credential	:
Telephone Number	:	952-239-6466

Provider Enumeration Date	:	03/03/2026
Last Update Date	:	03/03/2026

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