MEDICARE: GROWING TOGETHER PNCC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1669281960
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GROWING TOGETHER PNCC LLC

Provider Business Mailing Address
First Line	:	4937 N 38TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53209-5335
Country	:	US
Telephone Number	:	414-419-4542
Fax Number	:

Provider Business Practice Location Address
First Line	:	5600 W FOND DU LAC AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-1222
Country	:	US
Telephone Number	:	414-419-4542
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	YOLA V ANTHONY
Credential	:
Telephone Number	:	414-419-4542

Provider Enumeration Date	:	01/02/2025
Last Update Date	:	01/02/2025

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