Healthcare Provider Details

I. General information

NPI: 1063342129
Provider Name (Legal Business Name): PURE HEARTS CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 W NORTH AVE UNIT 416
MILWAUKEE WI
53212-3291
US

IV. Provider business mailing address

616 W NORTH AVE UNIT 416
MILWAUKEE WI
53212-3291
US

V. Phone/Fax

Practice location:
  • Phone: 414-387-7681
  • Fax:
Mailing address:
  • Phone: 414-387-7681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CORIA EVANS
Title or Position: OWNER
Credential: OWNER
Phone: 414-387-7681