Healthcare Provider Details

I. General information

NPI: 1881315190
Provider Name (Legal Business Name): HEATHER SCHNEIDER NON MEDICAL SERVICE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HEATHER FRIEND HOME AT EASE, LLC

II. Dates (important events)

Enumeration Date: 09/06/2022
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 E GRAND AVE # 1D
BELOIT WI
53511-6399
US

IV. Provider business mailing address

611 E GRAND AVE # 1D
BELOIT WI
53511-6399
US

V. Phone/Fax

Practice location:
  • Phone: 608-322-2660
  • Fax:
Mailing address:
  • Phone: 608-322-2660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: