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General NPI Number Information
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NPI Number | 1649748914
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Entity Type | Organization
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Legal Business Name | HUMBLE HEARTS ADULT FAMILY HOME LLC
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Dates
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Enumeration Date | 11/05/2018
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Last Update Date | 11/05/2018
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Provider Practice Location Address
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Address Line | 323 N 33RD ST
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City | MILWAUKEE
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State | WI
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Zip | 53208-4129
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Country | US
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Telephone | 414-539-3656
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Fax |
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Provider Business Mailing Address
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Address Line | 6054 N 37TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53209-3609
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Country | US
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Telephone | 414-539-3656
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ALICE CUNNING
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Credential |
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Telephone | 414-243-6975
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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