Organization
FULLY LOADED LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAVONNEY LOCKRIDGE (OWNER)
(262) 527-7490
Entity
Organization
Contact information
Practice address
1810 W FAIRMOUNT AVE, MILWAUKEE, WI 53209-5721
(262) 527-7490
Mailing address
1810 W FAIRMOUNT AVE, MILWAUKEE, WI 53209-5721
(262) 527-7490
Taxonomy
Speciality
Code
Description
License number
State
174200000X
Meals Provider
—
—
177F00000X
Lodging Provider
—
—
253Z00000X
In Home Supportive Care Agency
—
—
385H00000X
Respite Care
Primary
—
—
Other
Enumeration date
09/15/2025
Last updated
09/15/2025
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