MEDICARE: FAMILY HOUSE, INC

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	311ZA0620X	Adult Care Home Facility	6685-800	WI

General Provider Information

NPI Number	:	1750549382
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY HOUSE, INC

Provider Business Mailing Address
First Line	:	3269 N 11TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53206-2828
Country	:	US
Telephone Number	:	414-374-5212
Fax Number	:	414-374-1294

Provider Business Practice Location Address
First Line	:	3269 N 11TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53206-2828
Country	:	US
Telephone Number	:	414-374-5212
Fax Number	:	414-374-1294

Authorized Official
Title or Position	:	FINANCE MANGER
Name	:	MR. LEONEL DODZI AC-LUMOR
Credential	:
Telephone Number	:	414-374-5212

Provider Enumeration Date	:	05/30/2008
Last Update Date	:	05/30/2008

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Directions to “FAMILY HOUSE, INC ” Practice Location

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