MEDICARE: L & L ANCHORAGE HOMES II 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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1518783497
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	L & L ANCHORAGE HOMES II LLC

Provider Business Mailing Address
First Line	:	5340 W MELVINA ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-2218
Country	:	US
Telephone Number	:	414-550-8098
Fax Number	:	414-875-8272

Provider Business Practice Location Address
First Line	:	3843 N 51ST BLVD
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-2303
Country	:	US
Telephone Number	:	414-550-8098
Fax Number	:	414-875-8272

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LUREAN NELSON
Credential	:	RN
Telephone Number	:	414-550-8098

Provider Enumeration Date	:	11/25/2024
Last Update Date	:	11/25/2024

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