MEDICARE: GIFTED DIVERSITY HANDS,LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	253Z00000X	In Home Supportive Care Agency
2	385H00000X	Respite Care
3	374U00000X	Home Health Aide

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235818980
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GIFTED DIVERSITY HANDS,LLC

Provider Business Mailing Address
First Line	:	3940 W LISBON AVE APT 310
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53208-1883
Country	:	US
Telephone Number	:	414-552-3291
Fax Number	:	262-999-0150

Provider Business Practice Location Address
First Line	:	1728 W WRIGHT ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53206-2043
Country	:	US
Telephone Number	:	262-696-9711
Fax Number	:	262-999-0150

Authorized Official
Title or Position	:	OWNER
Name	:	SHAQUILLA RENEE HANNON
Credential	:	CARE PROVIDER
Telephone Number	:	414-552-3291

Provider Enumeration Date	:	07/11/2023
Last Update Date	:	08/28/2023

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