MEDICARE: STEVE'S HAVEN

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	171M00000X	Case Manager/Care Coordinator
2	172V00000X	Community Health Worker
3	385H00000X	Respite Care
4	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1609612944
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEVE'S HAVEN

Provider Business Mailing Address
First Line	:	2978 N 54TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53210-1631
Country	:	US
Telephone Number	:	414-640-8348
Fax Number	:

Provider Business Practice Location Address
First Line	:	2978 N 54TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53210-1631
Country	:	US
Telephone Number	:	414-640-8348
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ANGELA DENISE AUSTIN-WHERRY
Credential	:
Telephone Number	:	414-640-8348

Provider Enumeration Date	:	07/05/2024
Last Update Date	:	07/06/2024

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Directions to “STEVE'S HAVEN ” Practice Location

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