MEDICARE: ABLE LIVING 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	:	1215385729
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABLE LIVING LLC

Provider Business Mailing Address
First Line	:	4319 N 76TH ST STE 9
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53222-2056
Country	:	US
Telephone Number	:	414-210-5322
Fax Number	:

Provider Business Practice Location Address
First Line	:	4319 N 76TH ST STE 9
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53222-2056
Country	:	US
Telephone Number	:	414-210-5322
Fax Number	:	888-552-2970

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	MR. LAO CHANG
Credential	:
Telephone Number	:	414-210-5322

Provider Enumeration Date	:	05/25/2016
Last Update Date	:	12/14/2017

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