Healthcare Provider Details

I. General information

NPI: 1619341815
Provider Name (Legal Business Name): HEART FAILURE SURVIVAL CENTER OF AMERICA SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2015
Last Update Date: 12/14/2022
Certification Date: 12/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1281 MARINETTE AVE
MARINETTE WI
54143-2018
US

IV. Provider business mailing address

1281 MARINETTE AVE
MARINETTE WI
54143-2018
US

V. Phone/Fax

Practice location:
  • Phone: 715-330-7090
  • Fax: 715-732-0828
Mailing address:
  • Phone: 715-330-7090
  • Fax: 715-732-0828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number47840-20
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: BRENDA M QUAAK
Title or Position: PROJECT MANAGER
Credential:
Phone: 715-330-7090