Healthcare Provider Details

I. General information

NPI: 1427856970
Provider Name (Legal Business Name): LOVING HAVEN GROUP HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2025
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 N 68TH ST
MILWAUKEE WI
53218-1801
US

IV. Provider business mailing address

5900 N 68TH ST
MILWAUKEE WI
53218-1801
US

V. Phone/Fax

Practice location:
  • Phone: 414-433-9397
  • Fax: 414-433-9387
Mailing address:
  • Phone: 414-433-9397
  • Fax: 414-433-9387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name: KITANA KAHUE-HOO
Title or Position: OWNER/ DIRECTOR
Credential:
Phone: 414-379-2431