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General NPI Number Information
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NPI Number | 1376412460
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Entity Type | Organization
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Legal Business Name | PUREHEART HOME CARE LLC
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Dates
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Enumeration Date | 11/05/2025
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Last Update Date | 11/05/2025
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Provider Practice Location Address
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Address Line | 10920 W LINCOLN AVE STE 205
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City | WEST ALLIS
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State | WI
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Zip | 53227-1130
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Country | US
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Telephone | 262-770-0098
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Fax |
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Provider Business Mailing Address
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Address Line | 10920 W LINCOLN AVE STE 205
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City | WEST ALLIS
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State | WI
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Zip | 53227-1130
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Country | US
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Telephone | 262-770-0098
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LADASHIA SAMONE CANNON
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Credential |
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Telephone | 414-460-1400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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