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Organization
SUPPORTIVE CARE FAMILY HOME LLC
Active
Organization
SUPPORTIVE CARE FAMILY HOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIFFANY DABNEY (OWNER)
(414) 252-8442
Entity
Organization
Contact information
Practice address
4934 N 73RD ST, MILWAUKEE, WI 53218-3815
(414) 252-8442
Mailing address
4934 N 73RD ST, MILWAUKEE, WI 53218-3815
(414) 252-8442
Taxonomy
Speciality
Code
Description
License number
State
385H00000X
Respite Care
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
Primary
—
—
Other
Enumeration date
06/01/2021
Last updated
08/09/2023
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