Organization
MED GROUP ADULT DAY CARE OF WI
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DARIKO MEKVABISHVILI (PRESIDENT)
(414) 755-0558
Entity
Organization
Contact information
Practice address
6572 S LOVERS LANE RD, FRANKLIN, WI 53132-1209
(414) 755-0558
(414) 755-2470
Mailing address
11402 N PORT WASHINGTON RD, SUITE 215, MEQUON, WI 53092-3447
(414) 755-0558
(414) 755-1763
Taxonomy
Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
Primary
0014565
WI
Other
Enumeration date
11/06/2013
Last updated
11/06/2013
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