Genesis Adult Family Home LLC

NPI #1831974955 in Mequon, Wisconsin

Provider Information

NPI Number: 1831974955
Entity Type: Organization
Organization Name: Genesis Adult Family Home LLC
Primary Specialty: Intermediate Care Facility, Mental Illness
Enumeration Date: Aug 28, 2023
Last Updated: Aug 28, 2023

Practice Location

Address: 3315 W BURGUNDY CT
City: Mequon
State: Wisconsin
ZIP Code: 53092-5202
Phone: (262) 853-1344

Authorized Official

Name: WANDA BOONE
Title: DIRECTOR
Phone: (262) 853-1344

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Nursing Care	251J00000X
Nursing Facility/Intermediate Care Facility	313M00000X
Skilled Nursing Facility - Nursing Care, Pediatric — Nursing Care, Pediatric	3140N1450X
Intermediate Care Facility, Mental Illness	310500000X	Primary

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