Organization
831 ADULT LIVING FACILITY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DEMARVIS D JOHNSON SR. (PRESIDENT)
(414) 248-2724
Entity
Organization
Contact information
Practice address
5836 N 76TH ST, MILWAUKEE, WI 53218-1836
(414) 248-2724
Mailing address
5836 N 76TH ST, MILWAUKEE, WI 53218-1836
(414) 248-2724
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Enumeration date
07/07/2022
Last updated
07/07/2022
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