Provider Demographics
NPI:1588233217
Name:ESSENCE OF A VILLAGE PNCC LLC
Entity Type:Organization
Organization Name:ESSENCE OF A VILLAGE PNCC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CRISTIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:LEGREE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-234-1522
Mailing Address - Street 1:3610 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53405-1734
Mailing Address - Country:US
Mailing Address - Phone:262-234-1522
Mailing Address - Fax:
Practice Address - Street 1:3610 SPRING ST
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53405-1734
Practice Address - Country:US
Practice Address - Phone:262-234-1522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management