MEDICARE: DIVINE LIVING AFH 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	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility
2	385HR2055X	Child Mental Illness Respite Care
3	385H00000X	Respite Care
4	3104A0630X	Assisted Living Facility (Behavioral Disturbances)
5	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care
6	311500000X	Alzheimer Center (Dementia Center)
7	3104A0625X	Assisted Living Facility (Mental Illness)	0014243	WI
8	320700000X	Physical Disabilities Residential Treatment Facility
9	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1043635923
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVINE LIVING AFH LLC

Provider Business Mailing Address
First Line	:	7752 W BRENTWOOD AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53223-6106
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7752 W BRENTWOOD AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53223-6106
Country	:	US
Telephone Number	:	414-803-1043
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROSETTA STRONG
Credential	:
Telephone Number	:	414-803-1043

Provider Enumeration Date	:	02/28/2014
Last Update Date	:	01/16/2026

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Directions to “DIVINE LIVING AFH LLC ” Practice Location

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