=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851264220
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NURTURING HEARTS HOMECARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/24/2025
-----------------------------------------------------
Last Update Date | 09/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3624 CLAIRMONT ST
-----------------------------------------------------
City | RACINE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53406-5342
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-880-4713
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3622 CLAIRMONT ST
-----------------------------------------------------
City | RACINE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53406-5342
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-880-4713
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ADMINISTRATOR
-----------------------------------------------------
Name | EBONY CUNNINGHAM
-----------------------------------------------------
Credential | CNA
-----------------------------------------------------
Telephone | 262-880-4713
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 320900000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------