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General NPI Number Information
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NPI Number | 1952051211
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Entity Type | Organization
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Legal Business Name | 1 HEAVENLY DIVINE ADULT FAMILY HOMES LLC
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Dates
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Enumeration Date | 03/28/2022
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Last Update Date | 07/10/2025
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Provider Practice Location Address
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Address Line | 4637 N 24TH PL
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City | MILWAUKEE
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State | WI
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Zip | 53209-6206
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Country | US
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Telephone | 414-350-3558
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Fax | 414-979-0092
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Provider Business Mailing Address
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Address Line | PO BOX 16545
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City | MILWAUKEE
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State | WI
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Zip | 53216-0545
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Country | US
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Telephone | 414-350-3558
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Fax | 414-979-0092
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Authorized Official
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Title or Position | OWNER
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Name | KATHY JONES
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Credential |
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Telephone | 414-350-3558
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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