MEDICARE: POTTERS HOUSE PNCC SERVICES

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	:	1790350908
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POTTERS HOUSE PNCC SERVICES

Provider Business Mailing Address
First Line	:	824 S 18TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53204-1125
Country	:	US
Telephone Number	:	414-419-1025
Fax Number	:	414-810-0523

Provider Business Practice Location Address
First Line	:	2110 W NATIONAL AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53204-1159
Country	:	US
Telephone Number	:	414-940-8564
Fax Number	:	414-810-0523

Authorized Official
Title or Position	:	OWNER
Name	:	MS. DEQUANA BOSTICK
Credential	:
Telephone Number	:	414-419-1025

Provider Enumeration Date	:	05/21/2021
Last Update Date	:	05/21/2021

Similar Medicare Providers

1154137859 — TERI CLEGGETT
Practice Location Address:

7031 W BURLEIGH ST
MILWAUKEE, WI
53210-1159

Practice Phone: 414-639-8939
Practice Fax:

1871472605 — SARAH JEAN DESCH
Practice Location Address:

1825 E LAFAYETTE PL APT O
MILWAUKEE, WI
53202-1159

Practice Phone: 414-292-7484
Practice Fax:

1316068331 — MS. YOLANDA MICHELLE TOLSON R.P.H
Practice Location Address:

1032 S CESAR E CHAVEZ DR
MILWAUKEE, WI
53204-2203

Practice Phone: 414-999-4000
Practice Fax: 414-999-4399

1407565971 — DR. SUNDEEP SINGH KHAHRA
Practice Location Address:

1432 W FOREST HOME AVE
MILWAUKEE, WI
53204-3228

Practice Phone: 414-277-8960
Practice Fax:

1053242198 — KATIA SUSTAYTA CASTRO
Practice Location Address:

1032 S 16TH ST
MILWAUKEE, WI
53204-2203

Practice Phone: 414-672-1353
Practice Fax:

1154873958 — MATTHEW REILAND PH.D.
Practice Location Address:

1314 S 1ST ST # 108
MILWAUKEE, WI
53204-2405

Practice Phone: 414-336-8484
Practice Fax: 414-432-2531

Directions to “POTTERS HOUSE PNCC SERVICES ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.