MEDICARE: DIVINE LOVE ADULT DAY CARE CENTER, 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	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1437807211
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVINE LOVE ADULT DAY CARE CENTER, LLC

Provider Business Mailing Address
First Line	:	6245 W FOND DU LAC AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53218-4905
Country	:	US
Telephone Number	:	414-248-9271
Fax Number	:

Provider Business Practice Location Address
First Line	:	6245 W FOND DU LAC AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53218-4905
Country	:	US
Telephone Number	:	414-248-9271
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	JOCELYN WRIGHT HALL
Credential	:	BS,MS, PHD
Telephone Number	:	414-248-9271

Provider Enumeration Date	:	03/11/2022
Last Update Date	:	03/14/2022

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