Provider Demographics
NPI:1134584600
Name:RILEYS ADULT FAMILY HOME LLC
Entity type:Organization
Organization Name:RILEYS ADULT FAMILY HOME LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VERNISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-739-4264
Mailing Address - Street 1:3719 N 61ST ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-2101
Mailing Address - Country:US
Mailing Address - Phone:414-462-5532
Mailing Address - Fax:414-462-5529
Practice Address - Street 1:3719 N 61ST ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-2101
Practice Address - Country:US
Practice Address - Phone:414-462-5532
Practice Address - Fax:414-462-5529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-28
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health