Stonebrick Residential Living Facility LLC

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

Legal business name

STONEBRICK RESIDENTIAL LIVING FACILITY LLC

Practice address

4703 W Villard Ave
Milwaukee, WI 53218-4459

Phone

(414) 839-9906

Fax

(414) 435-0543

NPI assigned

Feb 1, 2016

Last updated

Feb 1, 2016By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Khalio Borum

Title

Facility Administrator

Phone

(414) 839-9906

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1454284800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1454284800000",
    "number": "1467810788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4703 W VILLARD AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532184459",
            "telephone_number": "414-839-9906",
            "fax_number": "414-435-0543"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4703 W VILLARD AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532184459",
            "telephone_number": "414-839-9906",
            "fax_number": "414-435-0543"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STONEBRICK RESIDENTIAL LIVING FACILITY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-01",
        "last_updated": "2016-02-01",
        "status": "A",
        "authorized_official_last_name": "BORUM",
        "authorized_official_first_name": "KHALIO",
        "authorized_official_title_or_position": "FACILITY ADMINISTRATOR",
        "authorized_official_telephone_number": "414-839-9906",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "WI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lucy Stone, MD
• Matthew Joseph Stone
• Reanin Stone
• Ryan A Stone, MD
• Rylee Stone
• Erik S Stonecipher, LPC
• Troy Brent Stonely, M.D.
• Kaylan R Stoner, CPNP-PC
• Kimberly M Stoner, MD
• Alexandra M Stong, FAMILY THERAPY

• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.