MEDICARE: GENTLE HEARTS AND LOUD LOVE ADULT FAMILY 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	311ZA0620X	Adult Care Home Facility

General Provider Information

NPI Number	:	1962232553
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENTLE HEARTS AND LOUD LOVE ADULT FAMILY HOME LLC

Provider Business Mailing Address
First Line	:	6845 LINDA DR
Second Line	:
City	:	WEST BEND
State	:	WI
Zip	:	53090-8935
Country	:	US
Telephone Number	:	414-690-2461
Fax Number	:

Provider Business Practice Location Address
First Line	:	6845 LINDA DR
Second Line	:
City	:	WEST BEND
State	:	WI
Zip	:	53090-8935
Country	:	US
Telephone Number	:	414-690-2461
Fax Number	:

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	KEAIRA STEPHENSON
Credential	:
Telephone Number	:	414-690-2461

Provider Enumeration Date	:	08/07/2024
Last Update Date	:	08/07/2024

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