MEDICARE: AMAZING ANGELS COMFORT AND SUPPORTIVE HOME CARE LLC

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1194660951
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMAZING ANGELS COMFORT AND SUPPORTIVE HOME CARE LLC

Provider Business Mailing Address
First Line	:	2333 N 11TH ST, MILWAUKEE, WI 53206, USA
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53206
Country	:	US
Telephone Number	:	414-394-0793
Fax Number	:	414-394-0793

Provider Business Practice Location Address
First Line	:	2032 W MICHIGAN ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53233-1906
Country	:	US
Telephone Number	:	414-394-0793
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. DOMANIKA STEVENS
Credential	:	STEVENS
Telephone Number	:	414-394-0793

Provider Enumeration Date	:	04/20/2026
Last Update Date	:	04/20/2026

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