Organization
LICENSED TO CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. NATASHA NICOLE BLAIR (LPN)
(414) 462-9111
Entity
Organization
Contact information
Practice address
5846 N 68TH ST, MILWAUKEE, WI 53218-1808
(414) 462-9111
Mailing address
5846 N 68TH ST, MILWAUKEE, WI 53218-1808
(414) 462-9111
Taxonomy
Speciality
Code
Description
License number
State
311500000X
Alzheimer Center (Dementia Center)
Primary
303906-031
WI
311Z00000X
Custodial Care Facility
303906-031
WI
Other
Enumeration date
02/15/2011
Last updated
02/15/2011
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