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CLEAN SLATE ADULT FAMILY HOME CORP.
NPI 1497571541
Custodial Care Facility - Adult Care Home in Milwaukee, WI

Active since November 22, 2024
5100 N 77TH ST, MILWAUKEE, WI 53218(414) 616-1868 Get Directions Write a Review

NPPES record last updated: November 22, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Clean Slate Adult Family Home Corp. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CLEAN SLATE ADULT FAMILY HOME CORP. (NPI 1497571541) is a healthcare organization registered as an adult care home in Milwaukee, Wisconsin and active in the NPI registry since November 2024. The organization lists Tyrone Simmon, Owner, as its authorized official.

NPPES Registry Identity

NPI1497571541
Entity TypeOrganization
Primary Taxonomy311ZA0620X
Legal Business NameCLEAN SLATE ADULT FAMILY HOME CORP.
Location Address5100 N 77TH STMilwaukee, WI 53218-3701
Mailing Address5743 N 77th StMilwaukee, WI 53218-2144 · (630) 234-4783
Phone(414) 616-1868
Organization SubpartNo
Authorized OfficialTyrone SimmonOwner · (630) 234-4783
Enumeration DateNovember 22, 2024
NPPES CertifiedNovember 22, 2024
✔ NPI 1497571541 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCustodial Care Facility · Adult Care HomeNursing & Custodial Care Facilities
Taxonomy Code311ZA0620X
Definition
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.
5100 N 77TH ST, Milwaukee, WI 53218
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Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Clean Slate Adult Family Home Corp.'s NPI number?

The NPI number for Clean Slate Adult Family Home Corp. is 1497571541. It was assigned to this organization in the NPPES registry on November 22, 2024.

Where is Clean Slate Adult Family Home Corp. located?

Clean Slate Adult Family Home Corp. is located at 5100 N 77th St, Milwaukee, WI 53218. The listed phone number is (414) 616-1868.

What is Clean Slate Adult Family Home Corp.'s specialty?

The primary specialty registered for this NPI is Custodial Care Facility, specializing in Adult Care Home, with taxonomy code 311ZA0620X.

When was this NPI record last updated?

The NPPES record for Clean Slate Adult Family Home Corp. was last updated on November 22, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 20 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.