Provider Demographics
NPI:1962396556
Name:GWENMAR LLC
Entity type:Organization
Organization Name:GWENMAR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GWENLODYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-699-3518
Mailing Address - Street 1:4230 N 53RD ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-1343
Mailing Address - Country:US
Mailing Address - Phone:414-699-3518
Mailing Address - Fax:520-423-3901
Practice Address - Street 1:4230 N 53RD ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-1343
Practice Address - Country:US
Practice Address - Phone:414-699-3518
Practice Address - Fax:520-423-3901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-06
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
No374U00000XNursing Service Related ProvidersHome Health Aide
No253Z00000XAgenciesIn Home Supportive Care