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General NPI Number Information
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NPI Number | 1467366039
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Entity Type | Organization
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Legal Business Name | HEART OF LYNN ADULT FAMILY HOME
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Dates
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Enumeration Date | 09/30/2026
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Last Update Date | 09/30/2026
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Provider Practice Location Address
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Address Line | 9617 W GOODRICH AVE
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City | MILWAUKEE
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State | WI
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Zip | 53224-2735
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Country | US
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Telephone | 414-394-1049
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Fax |
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Provider Business Mailing Address
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Address Line | 4113 N 73RD ST
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City | MILWAUKEE
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State | WI
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Zip | 53216-1043
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DESTINY POLK
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Credential |
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Telephone | 414-394-1049
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 276400000X
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Taxonomy Name | Substance Use Disorder Rehabilitation Hospital Unit
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License Number |
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License Number State | NULL
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Taxonomy #2
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State | NULL
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Taxonomy #3
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number |
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License Number State | NULL
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Taxonomy #4
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State | NULL
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