Provider Demographics
NPI:1528568102
Name:NEW HOPE ADULT COMMUNITY CENTER
Entity Type:Organization
Organization Name:NEW HOPE ADULT COMMUNITY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:414-871-0350
Mailing Address - Street 1:2433 W ROOSEVELT DR
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-6640
Mailing Address - Country:US
Mailing Address - Phone:414-871-0350
Mailing Address - Fax:414-871-4219
Practice Address - Street 1:2433 W ROOSEVELT DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53209-6640
Practice Address - Country:US
Practice Address - Phone:414-871-0350
Practice Address - Fax:414-871-4219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI0014754261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care