MEDICARE: MENSA ADULT FAMILY 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	:	1083592729
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MENSA ADULT FAMILY HOME LLC

Provider Business Mailing Address
First Line	:	9621 W LAYTON AVE
Second Line	:
City	:	GREENFIELD
State	:	WI
Zip	:	53228-3339
Country	:	US
Telephone Number	:	414-628-9050
Fax Number	:	414-377-9531

Provider Business Practice Location Address
First Line	:	9621 W LAYTON AVE
Second Line	:
City	:	GREENFIELD
State	:	WI
Zip	:	53228-3339
Country	:	US
Telephone Number	:	414-628-9050
Fax Number	:	414-377-9531

Authorized Official
Title or Position	:	OWNER
Name	:	VICTORIA OCHI
Credential	:
Telephone Number	:	414-628-9050

Provider Enumeration Date	:	08/21/2025
Last Update Date	:	08/21/2025

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