MEDICARE: JL 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	251B00000X	Case Management Agency	109525	WI

General Provider Information

NPI Number	:	1811393366
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JL HEALTHCARE, LLC

Provider Business Mailing Address
First Line	:	3062 N 58TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53210-1545
Country	:	US
Telephone Number	:	414-217-2495
Fax Number	:	414-445-3893

Provider Business Practice Location Address
First Line	:	3062 N 58TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53210-1545
Country	:	US
Telephone Number	:	414-217-2495
Fax Number	:	414-445-3893

Authorized Official
Title or Position	:	CASE MANAGER
Name	:	MRS. JANICE M GORDEN
Credential	:	R.N.
Telephone Number	:	414-217-2495

Provider Enumeration Date	:	11/11/2014
Last Update Date	:	11/11/2014

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