Healthcare Provider Details

I. General information

NPI: 1427943992
Provider Name (Legal Business Name): M & M HOME CARE 2 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2025
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4117 W CUSTER AVE
MILWAUKEE WI
53209-4631
US

IV. Provider business mailing address

4117 W CUSTER AVE
MILWAUKEE WI
53209-4631
US

V. Phone/Fax

Practice location:
  • Phone: 414-429-7181
  • Fax:
Mailing address:
  • Phone: 414-429-7181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: GWENDOLYN MOSS
Title or Position: OWNER
Credential:
Phone: 414-429-7181