Organization
GOD SENT ADULT FAMILY HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DARRY TUCKER (MANAGER)
(414) 610-4720
Entity
Organization
Contact information
Practice address
3074 N 84TH ST, MILWAUKEE, WI 53222-4708
(414) 610-4720
Mailing address
3074 N 84TH ST, MILWAUKEE, WI 53222-4708
(414) 610-4720
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
—
—
Other
Enumeration date
12/14/2010
Last updated
12/14/2010
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