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General NPI Number Information
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NPI Number | 1053070003
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Entity Type | Organization
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Legal Business Name | HAVEN OF PEACE LLC
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Dates
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Enumeration Date | 12/16/2021
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Last Update Date | 03/23/2022
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Provider Practice Location Address
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Address Line | 3032 N 6TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53212-1907
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Country | US
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Telephone | 414-739-7587
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 11143
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City | MILWAUKEE
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State | WI
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Zip | 53211-0143
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Country | US
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Telephone | 414-739-7587
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Fax |
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Authorized Official
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Title or Position | CHIEF OF OPERATIONS
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Name | MALIKA A NICKELSON
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Credential |
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Telephone | 414-739-7587
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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