MEDICARE: FROM YOUR HOME 2 MY HEART SANCTUARY INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1285382952
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FROM YOUR HOME 2 MY HEART SANCTUARY INC

Provider Business Mailing Address
First Line	:	1808 N 13TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53205-1728
Country	:	US
Telephone Number	:	414-336-9747
Fax Number	:

Provider Business Practice Location Address
First Line	:	2568 N 19TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53206-2053
Country	:	US
Telephone Number	:	414-336-9747
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LYNETTE SMITH
Credential	:
Telephone Number	:	414-336-9747

Provider Enumeration Date	:	03/12/2022
Last Update Date	:	03/31/2022

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