MEDICARE: LIVE IN COLOR SUPPORTIVE INDEPENDENT LIVING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency
2	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1043188329
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIVE IN COLOR SUPPORTIVE INDEPENDENT LIVING

Provider Business Mailing Address
First Line	:	8015 S MONA DR
Second Line	:
City	:	OAK CREEK
State	:	WI
Zip	:	53154-3033
Country	:	US
Telephone Number	:	414-628-9205
Fax Number	:

Provider Business Practice Location Address
First Line	:	4345 N 60TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-1209
Country	:	US
Telephone Number	:	414-628-9205
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	VERNISHA TAYLOR
Credential	:
Telephone Number	:	414-628-9205

Provider Enumeration Date	:	10/28/2025
Last Update Date	:	12/01/2025

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