Provider Demographics
NPI:1437694338
Name:BEKUS ADULT DAY PROGRAM LLC
Entity Type:Organization
Organization Name:BEKUS ADULT DAY PROGRAM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ETTA
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-366-7309
Mailing Address - Street 1:4425 N 63RD ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53218-5548
Mailing Address - Country:US
Mailing Address - Phone:414-366-7309
Mailing Address - Fax:
Practice Address - Street 1:4425 N 63RD ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53218-5548
Practice Address - Country:US
Practice Address - Phone:414-366-7309
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-31
Last Update Date:2016-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI0015861251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services