OrganizationActive
Genesis Adult Family Home LLC
NPI 1831974955 · Mental Illness Intermediate Care Facility · Mequon, WI
Provider details
- NPI number
- 1831974955
- Entity type
- Organization
- Primary specialty
- Mental Illness Intermediate Care FacilityNursing & Custodial Care Facilities
- Organization subpart
- No
- Authorized official
- Wanda Boone, Director(262) 853-1344
Specialties & taxonomies
Nursing & Custodial Care Facilities
- Nursing Care Agency251J00000X
Agencies
Nursing & Custodial Care Facilities
- Pediatric Skilled Nursing Facility3140N1450X
Nursing & Custodial Care Facilities
Practice location
3315 W Burgundy Ct
Mequon, WI 53092-5202
Phone: (262) 853-1344
Approximate (ZIP-level) locationGet directions
Mailing address
3315 W Burgundy Ct
Mequon, WI 53092-5202
Registry dates
- Enumerated
- 2023-08-28
- Last updated
- 2023-08-28
- Certified
- 2023-08-28
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.