Organization
GENESIS ADULT FAMILY HOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WANDA BOONE (DIRECTOR)
(262) 853-1344
Entity
Organization
Contact information
Practice address
3315 W BURGUNDY CT, MEQUON, WI 53092-5202
(262) 853-1344
Mailing address
3315 W BURGUNDY CT, MEQUON, WI 53092-5202
(262) 853-1344
Taxonomy
Speciality
Code
Description
License number
State
251J00000X
Nursing Care Agency
—
—
310500000X
Mental Illness Intermediate Care Facility
Primary
—
—
313M00000X
Nursing Facility/Intermediate Care Facility
—
—
3140N1450X
Pediatric Skilled Nursing Facility
—
—
Other
Enumeration date
08/28/2023
Last updated
08/28/2023
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