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General NPI Number Information
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NPI Number | 1821670118
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Entity Type | Organization
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Legal Business Name | HEIZER, LLC
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Dates
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Enumeration Date | 04/26/2021
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Last Update Date | 04/26/2021
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Provider Practice Location Address
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Address Line | 9708 W THURSTON AVE
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City | MILWAUKEE
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State | WI
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Zip | 53225-2527
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Country | US
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Telephone | 414-935-2732
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Fax | 414-831-9978
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Provider Business Mailing Address
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Address Line | PO BOX 18115
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City | MILWAUKEE
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State | WI
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Zip | 53218-0115
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Country | US
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Telephone | 414-698-8782
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Fax |
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | TEKEYA A BRADSHAW
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Credential |
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Telephone | 414-698-8782
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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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