Organization
DIVINE GRACE ADULT FAMILY HOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAURICE JACKSON SR (OWNER)
(414) 379-3001
Entity
Organization
Contact information
Practice address
7727 W GLENDALE AVE, MILWAUKEE, WI 53218-5331
(414) 274-9935
Mailing address
7727 W GLENDALE AVE, MILWAUKEE, WI 53218-5331
Taxonomy
Speciality
Code
Description
License number
State
311500000X
Alzheimer Center (Dementia Center)
Primary
—
—
Other
Enumeration date
03/02/2026
Last updated
03/02/2026
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