Provider Demographics
NPI:1184943540
Name:HEAVENLY TOUCH NURSING
Entity type:Organization
Organization Name:HEAVENLY TOUCH NURSING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:MISS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:CLAY
Authorized Official - Suffix:
Authorized Official - Credentials:RN, LNC
Authorized Official - Phone:414-207-7751
Mailing Address - Street 1:5606 N 94TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53225-2602
Mailing Address - Country:US
Mailing Address - Phone:414-207-7751
Mailing Address - Fax:
Practice Address - Street 1:5606 N 94TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53225-2602
Practice Address - Country:US
Practice Address - Phone:414-207-7751
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15039930314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility