MEDICARE: CENTER OF LIFE 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	:	1669297446
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER OF LIFE ADULT FAMILY HOME LLC

Provider Business Mailing Address
First Line	:	2744 N 46TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53210-2431
Country	:	US
Telephone Number	:	414-248-1766
Fax Number	:

Provider Business Practice Location Address
First Line	:	2744 N 46TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53210-2431
Country	:	US
Telephone Number	:	414-248-1766
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	SHAMIKO BROWN
Credential	:
Telephone Number	:	414-248-1766

Provider Enumeration Date	:	11/18/2024
Last Update Date	:	01/05/2026

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