MEDICARE: TENDERNESS MEDICAL CENTER 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	:	1841981297
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TENDERNESS MEDICAL CENTER LLC

Provider Business Mailing Address
First Line	:	1919 W NORTH AVE STE B20
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53205-1101
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1919 W NORTH AVE STE B20
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53205-1101
Country	:	US
Telephone Number	:	305-335-8288
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JESSICA VAZQUEZ
Credential	:
Telephone Number	:	305-335-8288

Provider Enumeration Date	:	05/17/2023
Last Update Date	:	05/17/2023

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