MEDICARE: LOVE AND HEART ADULT FAMILY HOME

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	320800000X	Mental Illness Community Based Residential Treatment Facility
2	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1629911003
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOVE AND HEART ADULT FAMILY HOME

Provider Business Mailing Address
First Line	:	3500 N SHERMAN BLVD
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-3463
Country	:	US
Telephone Number	:	414-737-3081
Fax Number	:	414-231-3135

Provider Business Practice Location Address
First Line	:	3500 N SHERMAN BLVD
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-3463
Country	:	US
Telephone Number	:	414-737-3081
Fax Number	:	414-231-3135

Authorized Official
Title or Position	:	CEO
Name	:	MELISSA ANNE WILLOCK
Credential	:	NURSE
Telephone Number	:	414-737-3081

Provider Enumeration Date	:	04/10/2026
Last Update Date	:	04/10/2026

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