Provider Demographics
NPI:1447009840
Name:ITS A PASSION ADULT FAMILY HOME LLC
Entity type:Organization
Organization Name:ITS A PASSION ADULT FAMILY HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARGO
Authorized Official - Middle Name:ELISHA
Authorized Official - Last Name:DAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-732-4485
Mailing Address - Street 1:8487 KETTLE MORAINE DR
Mailing Address - Street 2:
Mailing Address - City:KEWASKUM
Mailing Address - State:WI
Mailing Address - Zip Code:53040-9213
Mailing Address - Country:US
Mailing Address - Phone:414-732-4485
Mailing Address - Fax:
Practice Address - Street 1:8487 KETTLE MORAINE DR
Practice Address - Street 2:
Practice Address - City:KEWASKUM
Practice Address - State:WI
Practice Address - Zip Code:53040-9213
Practice Address - Country:US
Practice Address - Phone:414-732-4485
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization