Provider Demographics
NPI:1174103162
Name:FRIENDS OF FAMILY ADULT HOME, LLC
Entity type:Organization
Organization Name:FRIENDS OF FAMILY ADULT HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PWANA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:RANDALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-639-2281
Mailing Address - Street 1:5322 N 73RD ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53218-2823
Mailing Address - Country:US
Mailing Address - Phone:414-639-2281
Mailing Address - Fax:
Practice Address - Street 1:5486 N 75TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53218-2712
Practice Address - Country:US
Practice Address - Phone:414-639-2281
Practice Address - Fax:414-800-6855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-13
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health