Provider Demographics
NPI:1083381123
Name:HUMBLED HEARTS CARE PRENATAL SERVICES
Entity Type:Organization
Organization Name:HUMBLED HEARTS CARE PRENATAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAHLILA
Authorized Official - Middle Name:
Authorized Official - Last Name:FENNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-870-3136
Mailing Address - Street 1:N175 W11117 STONEWOOD DR.
Mailing Address - Street 2:STE 250
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-6508
Mailing Address - Country:US
Mailing Address - Phone:262-415-5020
Mailing Address - Fax:262-415-5018
Practice Address - Street 1:N175 W11117 STONEWOOD DR.
Practice Address - Street 2:STE 250
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022-6508
Practice Address - Country:US
Practice Address - Phone:262-415-5020
Practice Address - Fax:262-415-5018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management