MEDICARE: MS. CLEAN CLEANING SERVICE L.L.C.

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	171W00000X	Contractor

General Provider Information

NPI Number	:	1528301983
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MS. CLEAN CLEANING SERVICE L.L.C.

Provider Business Mailing Address
First Line	:	2431 W GALENA ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53205-1429
Country	:	US
Telephone Number	:	414-534-9959
Fax Number	:

Provider Business Practice Location Address
First Line	:	2431 W GALENA ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53205-1429
Country	:	US
Telephone Number	:	414-534-9959
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MS. NAKITA DEBERRY
Credential	:	CERTIFIED IN PCW/SHC
Telephone Number	:	414-534-9959

Provider Enumeration Date	:	04/03/2013
Last Update Date	:	04/18/2016

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