Provider Demographics
NPI:1851003768
Name:ADAMS, JOSEPHINE KVETTE
Entity Type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:KVETTE
Last Name:ADAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 511241
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-2041
Mailing Address - Country:US
Mailing Address - Phone:414-426-2600
Mailing Address - Fax:
Practice Address - Street 1:21530 W LOCHLEVEN LN
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53146-4736
Practice Address - Country:US
Practice Address - Phone:262-710-4448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-22
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities