Provider Demographics
NPI:1922720119
Name:HAECCEITY SUPPORTIVE CARE LLC
Entity Type:Organization
Organization Name:HAECCEITY SUPPORTIVE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHEMIAH
Authorized Official - Middle Name:BRANDY
Authorized Official - Last Name:AMUGHMUN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:414-865-4070
Mailing Address - Street 1:6450 W FOREST HOME AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53220-2401
Mailing Address - Country:US
Mailing Address - Phone:414-865-4070
Mailing Address - Fax:414-249-3471
Practice Address - Street 1:6450 W FOREST HOME AVE STE 102
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53220-2401
Practice Address - Country:US
Practice Address - Phone:414-865-4070
Practice Address - Fax:414-249-3471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care