Provider Demographics
NPI:1003360777
Name:WALCARE ADULT FAMILY HOME LLC
Entity Type:Organization
Organization Name:WALCARE ADULT FAMILY HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:414-841-1654
Mailing Address - Street 1:3912 N 67TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-2008
Mailing Address - Country:US
Mailing Address - Phone:414-861-1654
Mailing Address - Fax:414-204-8273
Practice Address - Street 1:3912 N 67TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-2008
Practice Address - Country:US
Practice Address - Phone:414-841-1654
Practice Address - Fax:414-402-8273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI0015921310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility