Active NPI
Tiffany Powell
- Adult Care Home Facility
- Kenosha, WI
National Provider Identifier
1992495618
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Care Home Facility
- License
- 0016623
- Practice address
- 4047 32ND Ave
Kenosha, WI 53144-1914 - Phone
- (262) 914-2216
- NPI assigned
- May 8, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Care Home Facility | 311ZA0620X | 0016623 | WI | Primary |
Addresses
Primary practice location
4047 32ND Ave
Kenosha, WI 53144-1914
Mailing address
6815 32ND Ave
Kenosha, WI 53142-3447
Phone (262) 914-2216
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0016623 | WI | MD | Adult Care Home Facility |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Powell Enterprises LLC | Adult Care Home | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1683504000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1683504000000",
"number": "1992495618",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6815 32ND AVE",
"city": "KENOSHA",
"state": "WI",
"postal_code": "531423447",
"telephone_number": "262-914-2216"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4047 32ND AVE",
"city": "KENOSHA",
"state": "WI",
"postal_code": "531441914",
"telephone_number": "262-914-2216"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POWELL",
"first_name": "TIFFANY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-05-08",
"last_updated": "2023-05-08",
"certification_date": "2023-05-08",
"status": "A"
},
"taxonomies": [
{
"code": "311ZA0620X",
"taxonomy_group": "",
"desc": "Custodial Care Facility, Adult Care Home",
"state": "WI",
"license": "0016623",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kenosha, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.