Provider Demographics
NPI:1366890196
Name:ASSISTED DAILY LIVING LLC
Entity type:Organization
Organization Name:ASSISTED DAILY LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-271-5500
Mailing Address - Street 1:1121 N WAVERLY PL. STE 503
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-3475
Mailing Address - Country:US
Mailing Address - Phone:414-271-5500
Mailing Address - Fax:414-221-0507
Practice Address - Street 1:1121 N WAVERLY PL. STE. 503
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-3475
Practice Address - Country:US
Practice Address - Phone:414-271-5500
Practice Address - Fax:414-221-0507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-02
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care