Organization
CC' ADULT FAMILY HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CONDESA DELMAR CLARK (OWNER)
(262) 505-4531
Entity
Organization
Contact information
Practice address
4557 N 30TH ST, MILWAUKEE, WI 53209-6049
(414) 639-7107
Mailing address
4557 N 30TH ST, MILWAUKEE, WI 53209-6049
(414) 639-7107
Taxonomy
Speciality
Code
Description
License number
State
3104A0625X
Assisted Living Facility (Mental Illness)
Primary
—
—
Other
Enumeration date
12/30/2021
Last updated
12/30/2021
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