MEDICARE: NEW LIFE NEW LOVE ADULT FAMILY HOME, 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1457171282
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW LIFE NEW LOVE ADULT FAMILY HOME, LLC

Provider Business Mailing Address
First Line	:	6324 RIVER PKWY
Second Line	:
City	:	WAUWATOSA
State	:	WI
Zip	:	53213-1129
Country	:	US
Telephone Number	:	414-779-6344
Fax Number	:

Provider Business Practice Location Address
First Line	:	2121 N 24TH PL
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53205-1018
Country	:	US
Telephone Number	:	414-779-6344
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHAKEYA WILLIAMSON
Credential	:
Telephone Number	:	414-779-6344

Provider Enumeration Date	:	10/16/2024
Last Update Date	:	10/16/2024

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