Provider Demographics
NPI:1437807211
Name:DIVINE LOVE ADULT DAY CARE CENTER, LLC
Entity type:Organization
Organization Name:DIVINE LOVE ADULT DAY CARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOCELYN
Authorized Official - Middle Name:WRIGHT
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:BS,MS, PHD
Authorized Official - Phone:414-248-9271
Mailing Address - Street 1:6245 W FOND DU LAC AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53218-4905
Mailing Address - Country:US
Mailing Address - Phone:414-248-9271
Mailing Address - Fax:
Practice Address - Street 1:6245 W FOND DU LAC AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53218-4905
Practice Address - Country:US
Practice Address - Phone:414-248-9271
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-11
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care