Lake View Adult Family Home

NPI #1710119151 in Pewaukee, Wisconsin

Provider Information

NPI Number
1710119151
Entity Type
Organization
Organization Name
Lake View Adult Family Home
Primary Specialty
Community Health Worker
Enumeration Date
Aug 19, 2009
Last Updated
Aug 19, 2009

Practice Location

Address
W278N2456 PROSPECT AVE
ZIP Code
53072-5220
Phone
(414) 379-9713

Authorized Official

Name
MRS. DOUANGMALA PHRASAVATH, RN
Title
REGISTERED NURSE
Phone
(414) 379-9713

Specialties & Taxonomy Codes

Specialty
Community Health Worker

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