LE'DOVE AFH LLC (NPI# 1578809612) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578809612 |
| Entity Type | Organization |
| Organization Name | LE'DOVE AFH LLC |
| Practice Address |
724 Monticello Dr Racine WI 53402-3006 |
| Practice Telephone | 2626393253 |
| Practice Fax Number | 2626811174 |
| Mailing Telephone | 2626393253 |
| Mailing Fax Number | 2626811174 |
| Enumeration Date | 2012-12-18 |
| Last Update Date | 2012-12-18 |
| Authorized Official Name | MRS. ETHEL LEE LOCKRIDGE (OWNER) |
| Authorized Official Telephone | 2626393253 |
| Is Organization Subpart | Y |
| Parent Organization Name | LE'DOVE AFH LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 311ZA0620X |
Custodial Care Facility Specialization: Adult Care Home |
WI | Nursing & Custodial Care Facilities |
| Street Address |
724 MONTICELLO DR |
| City | RACINE |
| State | WI |
| Zip Code | 53402-3006 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215586847 | Jennifer Ann Wagener | Technician | 1513 Melvin Ave, Racine, WI 53402 | 2019-09-06 |
| 1023530490 | Tahir Vora | Pharmacist | 6840 Middle Rd Apt 8, Racine, WI 53402 | 2017-07-07 |
| 1154852069 | Golden Path Services | Home Health | 1700 North Main Street, Upper, Racine, WI 53402 | 2017-03-22 |
| 1376842690 | Vashir Jim Xiong | Acupuncturist | 3726 Ruby Ave, Racine, WI 53402 | 2011-03-25 |
| 1215248927 | Andrew M Asbury | Family Medicine | 2408 Four Mile Rd, Racine, WI 53402 | 2010-06-28 |
| 1215058532 | Lakeshore Family Dental Care Sc | Dentist | 3903 Douglas Ave, Racine, WI 53402 | 2007-04-03 |
| 1679626915 | David Ramon Reesman | Dentist | 3900 North Bay Dr, Racine, WI 53402 | 2007-01-19 |
| 1639286958 | Mary E Pagano | Internal Medicine | 5333 Douglas Ave, Racine, WI 53402 | 2006-08-23 |
| 1881605111 | Caledonia Chiropractic Clinic, Sc | Chiropractor | 5401 Douglas Ave, Suite A, Racine, WI 53402 | 2006-08-11 |
| 1003923996 | David C Zablotney | Family Medicine | 5333 Douglas Ave, Racine, WI 53402 | 2006-08-24 |
| Find all providers in zip 53402 | ||||
| Taxonomy Code | 311ZA0620X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Custodial Care Facility |
| Specialization | Adult Care Home |
| A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346790110 | Roots Residential Adult Family Home LLC | Custodial Care Facility | 1715 Lasalle St Uppr, Racine, WI 53402-4824 | 2016-10-05 |
| 1104081942 | Lillie House | Custodial Care Facility | 4618 Kinzie Ave, Racine, WI 53405-2212 | 2008-07-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912517475 | Estefania L Ocampo | Custodial Care Facility | 1512 S Union St, Milwaukee, WI 53204-2646 | 2020-08-08 |
| 1295353688 | Purposeful Living, LLC | Custodial Care Facility | 3928 W Galena St, Milwaukee, WI 53208-2340 | 2020-07-11 |
| 1750915575 | County of La Crosse | Custodial Care Facility | 856 Garland St E, West Salem, WI 54669 | 2020-03-02 |
| 1649814526 | Hadassah Care Homes Inc. | Custodial Care Facility | 4822 N 47th St, Milwaukee, WI 53218-4414 | 2019-11-04 |
| 1043869316 | S&s House of Hope, LLC | Custodial Care Facility | 1664 Terry Dale Dr, West Bend, WI 53090-8934 | 2019-09-09 |
| 1508415894 | Our Home Sweet Home LLC | Custodial Care Facility | 4101 N Montreal St, Milwaukee, WI 53216-1740 | 2019-09-09 |
| 1912553363 | Lisa Bender | Custodial Care Facility | 3335 N 50th St, Milwaukee, WI 53216-3213 | 2019-08-12 |
| 1417512260 | Open With Arms, LLC | Custodial Care Facility | 3906 N Vel R Phillips Ave, Milwaukee, WI 53212-1114 | 2019-05-07 |
| 1013480094 | Warming Hands Residential Service, LLC | Custodial Care Facility | 575 Schiller St, Sun Prairie, WI 53590-2072 | 2019-01-02 |
| 1427533033 | Hughes N Hughes | Custodial Care Facility | 3700 N 60th St, Milwaukee, WI 53216-2131 | 2018-09-28 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.