MEDICARE: V&R ADULT FAMILY HOME

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility
2	385H00000X	Respite Care
3	311ZA0620X	Adult Care Home Facility

General Provider Information

NPI Number	:	1417803099
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	V&R ADULT FAMILY HOME

Provider Business Mailing Address
First Line	:	3211 N 3RD ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53212-2023
Country	:	US
Telephone Number	:	414-837-0353
Fax Number	:

Provider Business Practice Location Address
First Line	:	3211 N 3RD ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53212-2023
Country	:	US
Telephone Number	:	414-837-0353
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DONNA JACKSON
Credential	:	LPN
Telephone Number	:	414-628-5102

Provider Enumeration Date	:	03/06/2026
Last Update Date	:	03/06/2026

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