Provider Demographics
NPI:1174330666
Name:E & A ADULT FAMILY HOME LLC MILKY WAY
Entity type:Organization
Organization Name:E & A ADULT FAMILY HOME LLC MILKY WAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EBRIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:JARJU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-598-7849
Mailing Address - Street 1:726 MILKY WAY
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53718-2920
Mailing Address - Country:US
Mailing Address - Phone:608-598-7849
Mailing Address - Fax:
Practice Address - Street 1:726 MILKY WAY
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53718-2920
Practice Address - Country:US
Practice Address - Phone:608-598-7849
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health