Organization
M AND T ADULT FAMILY HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LATANYA PIERCE (OWNER)
(414) 388-6200
Entity
Organization
Contact information
Practice address
1714 W CENTER ST, MILWAUKEE, WI 53206-2106
(414) 388-6200
Mailing address
1714 W CENTER ST, MILWAUKEE, WI 53206-2106
(414) 388-6200
Taxonomy
Speciality
Code
Description
License number
State
3104A0625X
Assisted Living Facility (Mental Illness)
—
—
311ZA0620X
Adult Care Home Facility
Primary
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
320700000X
Physical Disabilities Residential Treatment Facility
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
385H00000X
Respite Care
—
—
385HR2055X
Child Mental Illness Respite Care
—
—
Other
Enumeration date
04/06/2023
Last updated
04/06/2023
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