Provider Demographics
NPI:1275184004
Name:ARIES ADULT FAMILY HOME LLC
Entity Type:Organization
Organization Name:ARIES ADULT FAMILY HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAQUISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:COKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-332-8221
Mailing Address - Street 1:604 SYDNEY DR
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53402-3010
Mailing Address - Country:US
Mailing Address - Phone:262-332-8221
Mailing Address - Fax:
Practice Address - Street 1:604 SYDNEY DR
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53402-3010
Practice Address - Country:US
Practice Address - Phone:262-332-8221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-23
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No253Z00000XAgenciesIn Home Supportive Care