MEDICARE: KAY'S HEART LLC

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	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1851088850
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAY'S HEART LLC

Provider Business Mailing Address
First Line	:	2403 N 36TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53210-3040
Country	:	US
Telephone Number	:	414-499-7873
Fax Number	:

Provider Business Practice Location Address
First Line	:	2403 N 36TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53210-3040
Country	:	US
Telephone Number	:	414-499-7873
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CARE WORKER
Name	:	KATARA M MOFFETT
Credential	:
Telephone Number	:	414-499-7873

Provider Enumeration Date	:	04/19/2023
Last Update Date	:	04/19/2023

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Directions to “KAY'S HEART LLC ” Practice Location

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