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Organization
HAVEN OF PEACE SHC LLC
Active
Organization
HAVEN OF PEACE SHC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JALONG M EVANS (OWNER)
(414) 739-7587
Entity
Organization
Contact information
Practice address
2359 N SHERMAN BLVD, MILWAUKEE, WI 53210-2945
(414) 739-7587
(414) 434-3222
Mailing address
2359 N SHERMAN BLVD, MILWAUKEE, WI 53210-2945
(414) 739-7587
(414) 434-3222
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
3104A0625X
Assisted Living Facility (Mental Illness)
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
Other
Enumeration date
01/22/2024
Last updated
01/22/2024
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