Healthcare Provider Details

I. General information

NPI: 1114870136
Provider Name (Legal Business Name): HEAVENLY DIVINE PERSONAL CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2026
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W169N11506 BISCAYNE DR
GERMANTOWN WI
53022-3228
US

IV. Provider business mailing address

W169N11506 BISCAYNE DR
GERMANTOWN WI
53022-3228
US

V. Phone/Fax

Practice location:
  • Phone: 414-274-9789
  • Fax:
Mailing address:
  • Phone: 414-275-4748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: MICHA V DAVIS
Title or Position: OWNER
Credential:
Phone: 414-274-9789