Provider Demographics
NPI:1043554090
Name:RASHADA ADULT FAMILY HOME
Entity type:Organization
Organization Name:RASHADA ADULT FAMILY HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:KAMILAH
Authorized Official - Middle Name:
Authorized Official - Last Name:RASHADA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-840-3049
Mailing Address - Street 1:4083 N MONTREAL ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-1754
Mailing Address - Country:US
Mailing Address - Phone:414-840-3049
Mailing Address - Fax:414-442-7105
Practice Address - Street 1:4083 N MONTREAL ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-1754
Practice Address - Country:US
Practice Address - Phone:414-840-3049
Practice Address - Fax:414-442-7105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI0013901310400000X, 347C00000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No347C00000XTransportation ServicesPrivate Vehicle
No385H00000XRespite Care FacilityRespite Care