NPIMap

Organization Active NPI

Humble Living Home Three

  • Case Management Agency
  • West Bend, WI
National Provider Identifier
1568173284
Registry record updated Dec 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Management AgencyTaxonomy code 251B00000X
Legal business name
HUMBLE LIVING HOME THREE
Practice address
925 Tower LN
West Bend, WI 53090-2425
Phone
(262) 239-1138
NPI assigned
Dec 13, 2022
Last updated
Dec 13, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
HUMBLE LIVING ADULT FAMILY GROUP HOME LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 13, 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 with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X NU Primary

Addresses

Primary practice location

925 Tower LN
West Bend, WI 53090-2425

Mailing address

925 Tower LN
West Bend, WI 53090-2425
Phone (262) 239-1138

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL humblelivingwb@gmail.com

National Provider Directory

National Provider Directory
Part of
Humble Living Adult Family Group Home LLC

Locations

925 Tower Ln
West Bend, WI 53090
Phone (262) 239-1138

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1670889600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670889600000",
    "number": "1568173284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "925 TOWER LN",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530902425",
            "telephone_number": "262-239-1138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "925 TOWER LN",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530902425",
            "telephone_number": "262-239-1138"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HUMBLE LIVING HOME THREE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HUMBLE LIVING ADULT FAMILY GROUP HOME LLC",
        "enumeration_date": "2022-12-13",
        "last_updated": "2022-12-13",
        "certification_date": "2022-12-13",
        "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": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "humblelivingwb@gmail.com",
            "affiliation": "N",
            "address_1": "925 Tower Ln",
            "city": "West Bend",
            "state": "WI",
            "country_code": "US",
            "postal_code": "530902425",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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 Dec 13, 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.