Provider Demographics
NPI:1770153397
Name:SWEET BLESSINGS PNCC LLC
Entity type:Organization
Organization Name:SWEET BLESSINGS PNCC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KEANA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-336-4850
Mailing Address - Street 1:2619 N 58TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53210-2238
Mailing Address - Country:US
Mailing Address - Phone:141-433-6485
Mailing Address - Fax:414-269-9562
Practice Address - Street 1:2619 N 58TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-2238
Practice Address - Country:US
Practice Address - Phone:414-336-4850
Practice Address - Fax:414-269-9562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-27
Last Update Date:2021-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100165767Medicaid