MEDICARE: MEDICAL SUPPORTIVE CARE 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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1619828498
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL SUPPORTIVE CARE LLC

Provider Business Mailing Address
First Line	:	660 N SPRING ST APT 324
Second Line	:
City	:	PORT WASHINGTON
State	:	WI
Zip	:	53074-9670
Country	:	US
Telephone Number	:	414-460-3080
Fax Number	:

Provider Business Practice Location Address
First Line	:	660 N SPRING ST APT 324
Second Line	:
City	:	PORT WASHINGTON
State	:	WI
Zip	:	53074-9670
Country	:	US
Telephone Number	:	414-460-3080
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MS. LAXENIA L HARVEY
Credential	:	CNA
Telephone Number	:	414-460-3080

Provider Enumeration Date	:	02/06/2026
Last Update Date	:	02/06/2026

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