Provider Demographics
NPI:1669281960
Name:GROWING TOGETHER PNCC LLC
Entity type:Organization
Organization Name:GROWING TOGETHER PNCC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YOLA
Authorized Official - Middle Name:V
Authorized Official - Last Name:ANTHONY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-419-4542
Mailing Address - Street 1:4937 N 38TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-5335
Mailing Address - Country:US
Mailing Address - Phone:414-419-4542
Mailing Address - Fax:
Practice Address - Street 1:5600 W FOND DU LAC AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-1222
Practice Address - Country:US
Practice Address - Phone:414-419-4542
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-02
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management