Organization
CLEAN SLATE ADULT FAMILY HOME CORP.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TYRONE SIMMONS (OWNER)
(630) 234-4783
Entity
Organization
Contact information
Practice address
5743 N 77TH ST, MILWAUKEE, WI 53218-2144
(262) 804-0099
Mailing address
5743 N 77TH ST, MILWAUKEE, WI 53218-2144
(262) 804-0099
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
—
—
Other
Enumeration date
02/19/2024
Last updated
11/22/2024
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