Healthcare Provider Details

I. General information

NPI: 1972069003
Provider Name (Legal Business Name): ANGEL HEARTS ADULT CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2019
Last Update Date: 02/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6661 W MILL RD
MILWAUKEE WI
53218-1238
US

IV. Provider business mailing address

6661 W MILL RD
MILWAUKEE WI
53218-1238
US

V. Phone/Fax

Practice location:
  • Phone: 414-378-8461
  • Fax:
Mailing address:
  • Phone: 414-378-8461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TERESA SMITH
Title or Position: PRESIDENT/ MANAGER OF OPERATIONS
Credential:
Phone: 414-378-8461