Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Clean Slate Adult Family Home Corp

Organization Adult Care Home Facility · NPI 1104681238

Clean Slate Adult Family Home Corp is an Adult Care Home Facility in Milwaukee, Wisconsin. Registered with an NPI since 2024.

In the registry since
2024
What do these letters mean?
Corp — Corporation
A form of business registration, not a clinical qualification.

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Practice location Address checks out

5743 N 77th St
Milwaukee, WI 53218-2144
Phone: (262) 804-0099
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Adult Care Home Facility (primary) Taxonomy 311ZA0620X

Record details

NPI number1104681238
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Tyrone Simmons — Owner · (630) 234-4783
NPI enumeratedFebruary 19, 2024
Last updated in NPPESNovember 22, 2024
Certification dateNovember 22, 2024
Mailing address5743 N 77th St, Milwaukee, WI 53218-2144

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