Aweis Jeilani Mohamed
Individual provider Active NPI Assisted Living Facility · Glendale, WI
NPI 1346089497 · NPPES record last updated May 30, 2024
Key facts
- NPI
- 1346089497
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Assisted Living Facility 310400000X
- License
- 0019889 (WI)
- Practice address
- 4610 N River Park Blvd
Glendale, WI 53209-6525 - Phone
- (614) 806-0618
- NPI assigned
- May 20, 2024
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0019889 | WI | MD | Assisted Living Facility |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Better Living Afh LLC | Assisted Living Facility | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Assisted Living Facility | 310400000X | 0019889 | WI | Yes |
Addresses
Primary practice location
4610 N River Park Blvd
Glendale, WI 53209-6525
Mailing address
4610 N River Park Blvd
Glendale, WI 53209-6525
Phone (614) 806-0618
Other providers in Glendale, WI
- Miracle Home Health of Wisconsin Inc
- Mobile Physician Clinics, LLC
- Alexandra Modell
- Patricia Ann Modell
- Stephen David Moerschel
- John Mooney
- Elizabeth Gayle Morgan
- Julie K Morgan
- Diane Marie Mosnik
- Leah Mott
All providers in Glendale, WI · Assisted Living Facility in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 30, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.