Healthcare Provider Details

I. General information

NPI: 1659243368
Provider Name (Legal Business Name): MOORE TRANQUILITY HOME LIVING LL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2025
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5653 N 36TH ST
MILWAUKEE WI
53209-4005
US

IV. Provider business mailing address

5653 N 36TH ST
MILWAUKEE WI
53209-4005
US

V. Phone/Fax

Practice location:
  • Phone: 414-346-6498
  • Fax:
Mailing address:
  • Phone: 414-346-6498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: JONIKA D MOORE
Title or Position: OWNER
Credential: ADULT FAMILY HOME
Phone: 414-346-6498