Healthcare Provider Details

I. General information

NPI: 1912293663
Provider Name (Legal Business Name): HART FAMILY INNOVATED CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2011
Last Update Date: 06/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 N MAYFAIR RD 202
MILWAUKEE WI
53226-3430
US

IV. Provider business mailing address

PO BOX 340992
MILWAUKEE WI
53234-0992
US

V. Phone/Fax

Practice location:
  • Phone: 877-692-0008
  • Fax: 414-908-9403
Mailing address:
  • Phone: 877-692-0008
  • Fax: 414-908-9403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MR. MARCUS CONTRELL HART
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 414-219-9039