Healthcare Provider Details

I. General information

NPI: 1598629206
Provider Name (Legal Business Name): MEMORRIES OF THE HEART LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 CENTER ST
RACINE WI
53403-2654
US

IV. Provider business mailing address

PO BOX 1774
MILWAUKEE WI
53201-1774
US

V. Phone/Fax

Practice location:
  • Phone: 414-324-8473
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. KEYELLIA MORRIES
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 414-324-8473