Provider Demographics
NPI:1578809612
Name:LE'DOVE AFH LLC
Entity Type:Organization
Organization Name:LE'DOVE AFH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ETHEL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:LOCKRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-639-3253
Mailing Address - Street 1:724 MONTICELLO DR
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53402-3006
Mailing Address - Country:US
Mailing Address - Phone:262-639-3253
Mailing Address - Fax:262-681-1174
Practice Address - Street 1:724 MONTICELLO DR
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53402-3006
Practice Address - Country:US
Practice Address - Phone:262-639-3253
Practice Address - Fax:262-681-1174
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LE'DOVE AFH LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-18
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home