Organization
CLEAN SLATE ADULT FAMILY HOME CORP.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TYRONE D SIMMON (OWNER)
(630) 234-4783
Entity
Organization
Contact information
Practice address
6918 W BIRCH CT, MILWAUKEE, WI 53218-2955
(414) 231-3108
Mailing address
5743 N 77TH ST, MILWAUKEE, WI 53218-2144
(630) 234-4783
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
—
—
Other
Enumeration date
11/22/2024
Last updated
11/22/2024
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