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Contact Information

JIMMIE C GRAYS
2903 15TH AVE
SOUTH MILWAUKEE, WI53172-3031
 Phone: 262-497-8448
 Fax: 262-681-3118
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Adult Care Home

311ZA0620X
 

Custodial Care Facility

311Z00000X
Indicates primary specialty

NPI Profile & details for

NPI # 1750276077
Entity Organization
Organization subpart 1 Not specified
Enumeration date 06/09/2025
Last updated 06/09/2025 - About 12 months ago
Identifiers
WI License # 0014387
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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