MEDICARE: NOURISHING HOME HEALTHCARE 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	:	1679142517
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOURISHING HOME HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	10536 W FOUNTAIN AVE APT 907
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53224-3236
Country	:	US
Telephone Number	:	301-300-7931
Fax Number	:

Provider Business Practice Location Address
First Line	:	10536 W FOUNTAIN AVE APT 907
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53224-3236
Country	:	US
Telephone Number	:	301-300-7931
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	CATRICIA L ROBERSON
Credential	:
Telephone Number	:	301-300-7931

Provider Enumeration Date	:	06/24/2021
Last Update Date	:	06/24/2021

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