Organization
LOVING ELDERLY ADULT DAY CARE CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NCAIS THAO VANG (OWNER)
(414) 243-5745
Entity
Organization
Contact information
Practice address
7017 N 58TH ST, MILWAUKEE, WI 53223-5204
(414) 207-6796
Mailing address
7017 N 58TH ST, MILWAUKEE, WI 53223-5204
(414) 207-6796
Taxonomy
Speciality
Code
Description
License number
State
103TA0700X
Adult Development & Aging Psychologist
Primary
—
—
103TM1800X
Intellectual & Developmental Disabilities Psychologist
—
—
171M00000X
Case Manager/Care Coordinator
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0017963
CETIFICATE
WI
01
—
V5206389587103
ID
WI
Enumeration date
03/12/2020
Last updated
03/12/2020
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