Individual provider · Type 1 NPI
Jimmie C. Grays
Adult Care Home Facility · South Milwaukee, WI
NPI number
1750276077
Active
Practice location
2903 15th Ave
South Milwaukee, WI 53172-3031
Fax (262) 681-3118
Mailing address
5221 Gallant Fox Ln
Caledonia, WI 53402-6100
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Adult Care Home Facility Primary | 311ZA0620X | 0014387 (WI) |
| Custodial Care Facility | 311Z00000X | 0014387 (WI) |
Adult Care Home Facility: A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment.
About NPI 1750276077
Jimmie C. Grays's National Provider Identifier is 1750276077, issued on Jun 9, 2025. The primary taxonomy on file is Adult Care Home Facility (311ZA0620X), and the practice location is in South Milwaukee, WI. The record was last updated on Jun 9, 2025.