| NPI | 1487319752 |
|---|---|
| Doing Business As | MC NICKELSON HAVEN OF LOVE |
| Entity Type | Organization |
| Authorized Contact | JALONG M EVANS Owner 414-739-8323 |
| Organization Subpart ? | No |
| Primary Taxonomy | 253Z00000X In Home Supportive Care |
| Additional Taxonomies | 251E00000X Home Health |
| 261QA0600X Clinic/Center, Adult Day Care | |
| 310400000X Assisted Living Facility | |
| 385H00000X Respite Care | |
| Enumeration Date | 2021-11-02 |
| Last Update Date | 2021-11-02 |