MEDICARE: MY LOVING 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1568140739
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MY LOVING HOME LLC

Provider Business Mailing Address
First Line	:	7830 W CALDWELL CT
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53218-3526
Country	:	US
Telephone Number	:	414-793-6660
Fax Number	:

Provider Business Practice Location Address
First Line	:	7830 W CALDWELL CT
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53218-3526
Country	:	US
Telephone Number	:	414-793-6660
Fax Number	:

Authorized Official
Title or Position	:	MANGER
Name	:	NATASHA CASSEL
Credential	:
Telephone Number	:	414-793-6660

Provider Enumeration Date	:	07/07/2023
Last Update Date	:	07/07/2023

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Directions to “MY LOVING HOME LLC ” Practice Location

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