MEDICARE: 4MOTHERS

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
2	251K00000X	Public Health or Welfare Agency

General Provider Information

NPI Number	:	1396282562
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	4MOTHERS

Provider Business Mailing Address
First Line	:	5226 W HAMPTON AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53218-5016
Country	:	US
Telephone Number	:	414-585-9896
Fax Number	:

Provider Business Practice Location Address
First Line	:	5226 W HAMPTON AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53218-5016
Country	:	US
Telephone Number	:	414-585-9896
Fax Number	:

Authorized Official
Title or Position	:	PROGRAM MANAGER
Name	:	AUBREY ZAILNER
Credential	:
Telephone Number	:	414-585-9896

Provider Enumeration Date	:	01/26/2017
Last Update Date	:	01/26/2017

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