5 Goodmen Community Care Group Home LLC

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

5 GOODMEN COMMUNITY CARE GROUP HOME LLC

Practice address

942 N 29TH St
Milwaukee, WI 53208-3406

Phone

(414) 988-5321

NPI assigned

Oct 10, 2024

Last updated

Oct 10, 2024By 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. George Weaver, B.A DEGREE

Title

Coo

Phone

(414) 309-2740

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1728518400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728518400000",
    "number": "1649090168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "942 N 29TH ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532083406",
            "telephone_number": "414-988-5321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "942 N 29TH ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532083406",
            "telephone_number": "414-988-5321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "5 GOODMEN COMMUNITY CARE GROUP HOME LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-10",
        "last_updated": "2024-10-10",
        "certification_date": "2024-10-10",
        "status": "A",
        "authorized_official_last_name": "WEAVER",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "414-309-2740",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "B.A    DEGREE"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2024; 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.