Organization
METHU ADULT FAMILY CARE HOME II
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES MWANGI METHU (PRESIDENT)
(414) 466-8930
Entity
Organization
Contact information
Practice address
2824 N 59TH ST, MILWAUKEE, WI 53210-1504
(414) 466-8930
(414) 873-4501
Mailing address
3070 N 55TH ST, MILWAUKEE, WI 53210-1563
(414) 466-8930
(414) 873-4501
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
0015250
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0015250
STATE OF WISCONSIN
WI
Enumeration date
10/23/2014
Last updated
10/23/2014
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