Organization
MED GROUP ADULT DAY CARE OF WI, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DARIKO MEKVABISHVILI (PRESIDENT)
(414) 755-0558
Entity
Organization
Contact information
Practice address
10549 W FOREST HOME AVE, HALES CORNERS, WI 53130-2057
(414) 755-0558
(414) 755-2470
Mailing address
10549 W FOREST HOME AVE, HALES CORNERS, WI 53130-2057
(414) 755-0558
(414) 755-2470
Taxonomy
Speciality
Code
Description
License number
State
311Z00000X
Custodial Care Facility
Primary
—
—
Other
Enumeration date
09/13/2012
Last updated
09/13/2012
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