MEDICARE: GWENMAR LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	374U00000X	Home Health Aide
2	253Z00000X	In Home Supportive Care Agency
3	385HR2055X	Child Mental Illness Respite Care

General Provider Information

NPI Number	:	1962396556
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GWENMAR LLC

Provider Business Mailing Address
First Line	:	4230 N 53RD ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-1343
Country	:	US
Telephone Number	:	414-699-3518
Fax Number	:	520-423-3901

Provider Business Practice Location Address
First Line	:	4230 N 53RD ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-1343
Country	:	US
Telephone Number	:	414-699-3518
Fax Number	:	520-423-3901

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. GWENLODYN MOSS
Credential	:
Telephone Number	:	414-699-3518

Provider Enumeration Date	:	06/06/2025
Last Update Date	:	06/06/2025

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Directions to “GWENMAR LLC ” Practice Location

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