CMS-1500 Box 24J / 33a • NPI
1952051211
Type 2 Organization (Box 32a/33a)
HIPAA NUCC Taxonomy • CMS Code
311ZA0620X
Licensed & Credentialed Custodial Care Facility, Adult Care Home
Box 32 Service Location & ZIP+4
4637 N 24TH PL, MILWAUKEE, WI, 53209-6206
✓ 9-Digit EDI 837 ZIP+4 (53209-6206)
✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR:
NPI
1952051211 (1 HEAVENLY DIVINE ADULT FAMILY HOMES LLC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).
CMS Medicare Order & Referring PECOS Eligibility
Official CMS NPPES Credential & Practice Profile
| 10-Digit NPI Number | 1952051211 (NPI-2 Organization / Facility) |
|---|---|
| Provider / Legal Name | 1 HEAVENLY DIVINE ADULT FAMILY HOMES LLC |
| Plain-English Specialty | Licensed & Credentialed Custodial Care Facility, Adult Care Home NUCC Code: 311ZA0620X (Custodial Care Facility, Adult Care Home) |
| Certifying / Licensing Body | State Medical / Healthcare Licensing Board & National Specialty Board |
| Practice Location Address | 4637 N 24TH PL, MILWAUKEE, WI, 53209-6206 |
| Practice Telephone / Fax | Tel: (414) 350-3558 | Fax: (414) 979-0092 |
| Administrative Mailing Address | PO BOX 16545, MILWAUKEE, WI, 53216-0545 |
| Enumeration & Last Sync | Enumerated: 2022-03-28 | CMS Record Updated: 2025-07-10 |
| Authorized Official | KATHY JONES (Owner) |
Clinic Location, Accessibility & Directions
📍 Practice Location & Patient Access
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Plain-English Taxonomy & CMS Crosswalk (311ZA0620X)
What Does Taxonomy Code 311ZA0620X Mean?
In the HIPAA National Uniform Claim Committee (NUCC) classification, code 311ZA0620X translates to:
"Licensed & Credentialed Custodial Care Facility, Adult Care Home"
Specialty Clinical Procedures & Therapeutic Classes
Standard Scope of Care (1 HEAVENLY DIVINE ADULT FAMILY HOMES LLC)
Typical CPT / Diagnostic Procedures:- Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
- Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
- Preventive Screening, Patient Counseling & Multidisciplinary Referral
- Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)
All Registered NUCC Taxonomies & State Licenses
| Taxonomy Code & Plain-English Description | State License & Primary Status |
|---|---|
310400000X — Assisted Living FacilityPlain English: Licensed & Credentialed Assisted Living Facility | State: N/A | License: Verified | Primary: Secondary |
311ZA0620X — Custodial Care Facility, Adult Care HomePlain English: Licensed & Credentialed Custodial Care Facility, Adult Care Home | State: N/A | License: Verified | Primary: Yes (Primary) |
Medical Billing, RCM & Hospital Credentialing Teams:
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