MEDICARE: HEAVENLY CARE

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1649541798
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEAVENLY CARE

Provider Business Mailing Address
First Line	:	PO BOX 44331
Second Line	:
City	:	WEST ALLIS
State	:	WI
Zip	:	53214-7331
Country	:	US
Telephone Number	:
Fax Number	:	414-434-1981

Provider Business Practice Location Address
First Line	:	1016 W PIERCE ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53204-1327
Country	:	US
Telephone Number	:	414-610-4557
Fax Number	:	414-434-1981

Authorized Official
Title or Position	:	PRESIDENT/ CEO
Name	:	BERNADETTE P RODRIGUEZ
Credential	:
Telephone Number	:	414-610-4557

Provider Enumeration Date	:	01/21/2012
Last Update Date	:	01/21/2012

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Directions to “HEAVENLY CARE ” Practice Location

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