Provider Demographics
NPI:1760500896
Name:HOME CARE WITH A HEART SC
Entity Type:Organization
Organization Name:HOME CARE WITH A HEART SC
Other - Org Name:THE CARING HEART
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER ADMINISTRATOR PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CARLEEN
Authorized Official - Middle Name:DEANN
Authorized Official - Last Name:TRENTADUE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:262-835-2887
Mailing Address - Street 1:PO BOX 251
Mailing Address - Street 2:4133 COURTNEY #7B
Mailing Address - City:FRANKSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53126
Mailing Address - Country:US
Mailing Address - Phone:262-835-2887
Mailing Address - Fax:262-835-4528
Practice Address - Street 1:4133 COURTNEY
Practice Address - Street 2:#7B
Practice Address - City:FRANKSVILLE
Practice Address - State:WI
Practice Address - Zip Code:53126
Practice Address - Country:US
Practice Address - Phone:262-835-2887
Practice Address - Fax:262-835-4528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1035251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1035OtherDHFS HHA LICENSE
WI43113100Medicaid
WI43113100Medicaid