Provider Demographics
NPI:1033836549
Name:HANDS OF LIFE PNCC LLC
Entity Type:Organization
Organization Name:HANDS OF LIFE PNCC LLC
Other - Org Name:HANDS OF LIFE PNCC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:C
Authorized Official - Last Name:VALENTINE JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-550-0252
Mailing Address - Street 1:915 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53205-1330
Mailing Address - Country:US
Mailing Address - Phone:859-550-0252
Mailing Address - Fax:
Practice Address - Street 1:915 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53205-1330
Practice Address - Country:US
Practice Address - Phone:859-550-0252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management