MEDICARE: ABUNDANT LIFE MINISTRY

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	3104A0630X	Assisted Living Facility (Behavioral Disturbances)

General Provider Information

NPI Number	:	1407037856
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABUNDANT LIFE MINISTRY

Provider Business Mailing Address
First Line	:	1904 E BELLEVIEW PL
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53211-3901
Country	:	US
Telephone Number	:	414-962-3200
Fax Number	:	414-962-3302

Provider Business Practice Location Address
First Line	:	1904 E BELLEVIEW PL
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53211-3901
Country	:	US
Telephone Number	:	414-962-3200
Fax Number	:	414-962-3302

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. RUTH RYSHKE
Credential	:	R.N.
Telephone Number	:	414-257-4350

Provider Enumeration Date	:	11/14/2007
Last Update Date	:	11/14/2007

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