MEDICARE: RESIDENTIAL LIVING SERVICES, 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	310400000X	Assisted Living Facility	310271	WI

General Provider Information

NPI Number	:	1790960946
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESIDENTIAL LIVING SERVICES, INC.

Provider Business Mailing Address
First Line	:	2014 W NORTH AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53205-1131
Country	:	US
Telephone Number	:	414-933-3929
Fax Number	:	414-933-3932

Provider Business Practice Location Address
First Line	:	2014 W NORTH AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53205-1131
Country	:	US
Telephone Number	:	414-933-3929
Fax Number	:	414-933-3932

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MS. JOANN HARRIS
Credential	:
Telephone Number	:	414-933-3929

Provider Enumeration Date	:	01/07/2008
Last Update Date	:	01/07/2008

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