Organization
SUPPORTIVE HOME LIVING SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KELLY KINGSTON (CEO)
(262) 544-0687
Entity
Organization
Contact information
Practice address
250 W BROADWAY STE 2, WAUKESHA, WI 53186-4848
(262) 544-0687
(262) 544-0715
Mailing address
250 W BROADWAY STE 2, WAUKESHA, WI 53186-4848
(262) 544-0687
(262) 544-0715
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251E00000X
Home Health Agency
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
347C00000X
Private Vehicle
—
—
Other
Enumeration date
09/23/2008
Last updated
09/23/2008
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