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NPI 1710119151

OrganizationActive

Lake View Adult Family Home

NPI 1710119151 · Community Health Worker · Pewaukee, WI

Provider details

NPI number: 1710119151
Entity type: Organization
Primary specialty: Community Health WorkerOther Service Providers
Authorized official: Douangmala Phrasavath, Registered Nurse

Practice location

W278n2456 Prospect Ave

Pewaukee, WI 53072-5220

Phone: (414) 379-9713

More WI providers

Mailing address

W278n2456 Prospect Ave

Pewaukee, WI 53072-5220

Registry dates

Enumerated: 2009-08-19
Last updated: 2009-08-19

Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.

Lake View Adult Family Home — NPI 1710119151, Pewaukee, WI | NPI Central