Healthcare Provider Details

I. General information

NPI: 1346161700
Provider Name (Legal Business Name): A GRATEFUL HEART SUPPORTIVE LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2834 N 52ND ST
MILWAUKEE WI
53210-1607
US

IV. Provider business mailing address

11805 W HAMPTON AVE # 102
MILWAUKEE WI
53225-3612
US

V. Phone/Fax

Practice location:
  • Phone: 414-488-9613
  • Fax:
Mailing address:
  • Phone: 414-488-9613
  • Fax: 414-265-8568

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: ROBBIE LASHELL MCNEICE
Title or Position: OWNER/CEO
Credential:
Phone: 414-265-8568