Provider Demographics
NPI:1407494081
Name:ADULT DAY SERVICES OF WISCONSIN LLC
Entity Type:Organization
Organization Name:ADULT DAY SERVICES OF WISCONSIN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LATASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-241-1103
Mailing Address - Street 1:PO BOX 13701
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213-0701
Mailing Address - Country:US
Mailing Address - Phone:414-241-1103
Mailing Address - Fax:414-486-1172
Practice Address - Street 1:206 E LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53207-1544
Practice Address - Country:US
Practice Address - Phone:414-241-1103
Practice Address - Fax:414-486-1172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-14
Last Update Date:2019-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services