MEDICARE: NV SUPPORTIVE 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1376361642
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NV SUPPORTIVE CARE LLC

Provider Business Mailing Address
First Line	:	3170 S 38TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53215-4009
Country	:	US
Telephone Number	:	414-578-7624
Fax Number	:

Provider Business Practice Location Address
First Line	:	3303 W NATIONAL AVE # 103
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53215-1113
Country	:	US
Telephone Number	:	414-578-7624
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NORA V VAZQUEZ-RAMOS
Credential	:
Telephone Number	:	414-578-7624

Provider Enumeration Date	:	09/26/2024
Last Update Date	:	09/26/2024

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