Provider Demographics
NPI:1649748914
Name:HUMBLE HEARTS ADULT FAMILY HOME LLC
Entity Type:Organization
Organization Name:HUMBLE HEARTS ADULT FAMILY HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:CUNNING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-243-6975
Mailing Address - Street 1:6054 N 37TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-3609
Mailing Address - Country:US
Mailing Address - Phone:414-539-3656
Mailing Address - Fax:
Practice Address - Street 1:323 N 33RD ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53208-4129
Practice Address - Country:US
Practice Address - Phone:414-539-3656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health