NPIMap

Organization Active NPI

Humble Living Adult Family Group Home LLC

  • Assisted Living Facility
  • West Bend, WI
National Provider Identifier
1477285484
Registry record updated Jun 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
Legal business name
HUMBLE LIVING ADULT FAMILY GROUP HOME LLC
Practice address
1124 W Washington St
West Bend, WI 53095-2434
Phone
(262) 239-1138
NPI assigned
Jun 28, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2022

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

Authorized official

Name
Vershaunda CampbellNPI 1508505728
Title
Owner
Phone
(262) 239-1138

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X Primary

Addresses

Primary practice location

1124 W Washington St
West Bend, WI 53095-2434

Mailing address

1124 W Washington St
West Bend, WI 53095-2434
Phone (262) 239-1138

Other names 1

  • Humble Living Adult Family Group Home LLC Doing business as

National Provider Directory

National Provider Directory

Ownership & related parties

Subparts reporting this organization as parent 2

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1656374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656374400000",
    "number": "1477285484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1124 W WASHINGTON ST",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530952434",
            "telephone_number": "262-239-1138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1124 W WASHINGTON ST",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530952434",
            "telephone_number": "262-239-1138"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HUMBLE LIVING ADULT FAMILY GROUP HOME LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-28",
        "last_updated": "2022-06-28",
        "certification_date": "2022-06-28",
        "status": "A",
        "authorized_official_last_name": "CAMPBELL",
        "authorized_official_first_name": "VERSHAUNDA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "262-239-1138"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Humble Living Adult Family Group Home LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in West Bend, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2022; 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.