Organization
POTTERS HOUSE PNCC SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DEQUANA BOSTICK (OWNER)
(414) 419-1025
Entity
Organization
Contact information
Practice address
2110 W NATIONAL AVE, MILWAUKEE, WI 53204-1159
(414) 940-8564
(414) 810-0523
Mailing address
824 S 18TH ST, MILWAUKEE, WI 53204-1125
(414) 419-1025
(414) 810-0523
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Enumeration date
05/21/2021
Last updated
05/21/2021
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