Healthcare Provider Details

I. General information

NPI: 1851972459
Provider Name (Legal Business Name): HEARTS OF REDEMPTION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2021
Last Update Date: 09/13/2021
Certification Date: 09/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3223 W LLOYD ST
MILWAUKEE WI
53208-1439
US

IV. Provider business mailing address

3223 W LLOYD ST
MILWAUKEE WI
53208-1439
US

V. Phone/Fax

Practice location:
  • Phone: 414-323-4243
  • Fax: 414-323-4049
Mailing address:
  • Phone: 414-323-4243
  • Fax: 414-323-4049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. BARBARA ANDERSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 414-323-4243