MEDICARE: HOUSE OF DAVID, 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	251B00000X	Case Management Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770758203
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOUSE OF DAVID, INC.

Provider Business Mailing Address
First Line	:	4417 W NORTH AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53208-1241
Country	:	US
Telephone Number	:	414-444-3013
Fax Number	:

Provider Business Practice Location Address
First Line	:	4417 W NORTH AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53208-1241
Country	:	US
Telephone Number	:	414-444-3013
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER/CEO
Name	:	MS. LURIDEAN NICHOLS
Credential	:
Telephone Number	:	414-444-3013

Provider Enumeration Date	:	04/25/2008
Last Update Date	:	04/25/2008

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Directions to “HOUSE OF DAVID, INC. ” Practice Location

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