MEDICARE: QUEEN ESTHER FAMILY AND SUPPORT SERVICES AGENCY LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251S00000X	Community/Behavioral Health Agency
2	251B00000X	Case Management Agency
3	251X00000X	Supports Brokerage Agency

General Provider Information

NPI Number	:	1710819925
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUEEN ESTHER FAMILY AND SUPPORT SERVICES AGENCY LLC

Provider Business Mailing Address
First Line	:	7635 W GLENBROOK RD
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53223-1006
Country	:	US
Telephone Number	:	414-553-5671
Fax Number	:

Provider Business Practice Location Address
First Line	:	7635 W GLENBROOK RD
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53223-1006
Country	:	US
Telephone Number	:	414-553-5671
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	PATRICIA LEWIS
Credential	:
Telephone Number	:	414-553-5671

Provider Enumeration Date	:	06/01/2026
Last Update Date	:	06/01/2026

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